Provider Demographics
NPI:1952642852
Name:MATSUYUKI, MASAMI (PHD)
Entity Type:Individual
Prefix:MS
First Name:MASAMI
Middle Name:
Last Name:MATSUYUKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 UNIVERSITY BLVE
Mailing Address - Street 2:112 ALLIE YOUNG HALL
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351
Mailing Address - Country:US
Mailing Address - Phone:606-783-2885
Mailing Address - Fax:606-783-9106
Practice Address - Street 1:112 ALLIE YOUNG HALL
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351
Practice Address - Country:US
Practice Address - Phone:606-783-2885
Practice Address - Fax:606-783-9106
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2012-88103T00000X
KYPSYLIP00211379103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist