Provider Demographics
NPI:1861867376
Name:BETH W MATTHEWS
Entity Type:Organization
Organization Name:BETH W MATTHEWS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:763-489-8430
Mailing Address - Street 1:1700 NIAGARA LN N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4739
Mailing Address - Country:US
Mailing Address - Phone:763-489-8430
Mailing Address - Fax:
Practice Address - Street 1:1700 NIAGARA LN N
Practice Address - Street 2:SUITE 201
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4911
Practice Address - Country:US
Practice Address - Phone:763-489-8430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREGNANCY & POSTPARTUM SUPPORT MINNESOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-09
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty