Provider Demographics
NPI:1851085377
Name:MATCHAM, ALEX (CCSS)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:MATCHAM
Suffix:
Gender:M
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 DESI LOOP
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-8068
Mailing Address - Country:US
Mailing Address - Phone:575-835-4357
Mailing Address - Fax:
Practice Address - Street 1:614 BECKER AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3634
Practice Address - Country:US
Practice Address - Phone:575-835-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator