Provider Demographics
NPI:1912002627
Name:MATTHEY, MICHELLE ADRIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ADRIAN
Last Name:MATTHEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-8906
Mailing Address - Country:US
Mailing Address - Phone:580-919-6511
Mailing Address - Fax:
Practice Address - Street 1:202 A ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:OK
Practice Address - Zip Code:73538-2153
Practice Address - Country:US
Practice Address - Phone:580-919-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX53197OtherLCSW LICENSURE
OK7134OtherLCSW LICENSURE