Provider Demographics
NPI:1922679919
Name:MATTHEWS, TANASIA CHARDAY
Entity Type:Individual
Prefix:
First Name:TANASIA
Middle Name:CHARDAY
Last Name:MATTHEWS
Suffix:
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 1:734A CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7831
Mailing Address - Country:US
Mailing Address - Phone:662-543-0307
Mailing Address - Fax:
Practice Address - Street 1:734A CLEARBROOK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7831
Practice Address - Country:US
Practice Address - Phone:662-543-0307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst