Provider Demographics
NPI:1740328442
Name:MATTHEWS, BRENDA ANN (LAC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:JUDSONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72081-9170
Mailing Address - Country:US
Mailing Address - Phone:501-729-3686
Mailing Address - Fax:
Practice Address - Street 1:3302 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4886
Practice Address - Country:US
Practice Address - Phone:501-268-4181
Practice Address - Fax:501-268-5301
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0702006101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor