Provider Demographics
NPI:1356526990
Name:MATTINGLY, STEPHANIE LOVE (BS)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LOVE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 EXCHANGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3364
Mailing Address - Country:US
Mailing Address - Phone:503-325-0241
Mailing Address - Fax:503-325-2853
Practice Address - Street 1:2120 EXCHANGE ST STE 301
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3364
Practice Address - Country:US
Practice Address - Phone:503-325-0241
Practice Address - Fax:503-325-2853
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor