Provider Demographics
NPI:1811204241
Name:MATKIN, RICHARD STEVEN (LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEVEN
Last Name:MATKIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13739 CRISHOLM RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8219
Mailing Address - Country:US
Mailing Address - Phone:208-989-9360
Mailing Address - Fax:
Practice Address - Street 1:1253 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8647
Practice Address - Country:US
Practice Address - Phone:208-376-7083
Practice Address - Fax:208-321-5069
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist