Provider Demographics
NPI:1790557866
Name:MATHEWSON, CHRISTOPHER I
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MATHEWSON
Suffix:I
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 1:968 4 MILE RD NW APT 2B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1530
Mailing Address - Country:US
Mailing Address - Phone:231-239-1117
Mailing Address - Fax:
Practice Address - Street 1:968 4 MILE RD NW APT 2B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-1530
Practice Address - Country:US
Practice Address - Phone:231-239-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician