Provider Demographics
NPI:1700549961
Name:MATHES, LORI KAYE (LMSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:MATHES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:VIBURNUM
Mailing Address - State:MO
Mailing Address - Zip Code:65566-8602
Mailing Address - Country:US
Mailing Address - Phone:573-604-2042
Mailing Address - Fax:
Practice Address - Street 1:103 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3247
Practice Address - Country:US
Practice Address - Phone:833-388-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021015933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker