Provider Demographics
NPI:1669625919
Name:MATHEWS, GEOFFREY (BS)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SW COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1353
Mailing Address - Country:US
Mailing Address - Phone:541-757-8068
Mailing Address - Fax:541-758-1030
Practice Address - Street 1:4515 SW COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1353
Practice Address - Country:US
Practice Address - Phone:541-757-8068
Practice Address - Fax:541-758-1030
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health