Provider Demographics
NPI:1659395861
Name:MATOSKY, JANICE H (LPC, LPA, LCCA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:MATOSKY
Suffix:
Gender:F
Credentials:LPC, LPA, LCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 QUAIL SPRINGS RD APT D3
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3706
Mailing Address - Country:US
Mailing Address - Phone:361-215-5877
Mailing Address - Fax:800-745-2060
Practice Address - Street 1:5151 FLYNN PKWY STE 412B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4367
Practice Address - Country:US
Practice Address - Phone:361-215-5877
Practice Address - Fax:800-745-2060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16780101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263724OtherCOMPSYCH
TX493233OtherVALUE OPTIONS
TX84587LOtherBLUE CROSS/BLUE SHIELD
TX0286734-03Medicaid
TX369025OtherMHN-TRICARE
TX5678237OtherFIRST HEALTH/CCN