Provider Demographics
NPI:1740895887
Name:MATTESON, STEPHEN (PHD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MATTESON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W UNIVERSITY AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3433
Mailing Address - Country:US
Mailing Address - Phone:765-747-4306
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE STE 401
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3433
Practice Address - Country:US
Practice Address - Phone:765-747-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist