Provider Demographics
NPI:1700195914
Name:MATTHEWS, LATAWYNA
Entity Type:Individual
Prefix:
First Name:LATAWYNA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-1973
Mailing Address - Country:US
Mailing Address - Phone:580-369-5850
Mailing Address - Fax:
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-1973
Practice Address - Country:US
Practice Address - Phone:580-369-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health