Provider Demographics
NPI:1922730365
Name:PREUITT, MATTHEW K (PENDING PCA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:K
Last Name:PREUITT
Suffix:
Gender:M
Credentials:PENDING PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 SE SUNNYSIDE RD STE 480
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5705
Mailing Address - Country:US
Mailing Address - Phone:503-739-8321
Mailing Address - Fax:971-209-7172
Practice Address - Street 1:10151 SE SUNNYSIDE RD STE 480
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5705
Practice Address - Country:US
Practice Address - Phone:503-739-8321
Practice Address - Fax:971-209-7172
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional