Provider Demographics
NPI:1891783478
Name:MATTHEWS, DOUG R (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUG
Middle Name:R
Last Name:MATTHEWS
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 1:1719 HILLHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5947
Mailing Address - Country:US
Mailing Address - Phone:714-778-1863
Mailing Address - Fax:
Practice Address - Street 1:101 E LINCOLN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3202
Practice Address - Country:US
Practice Address - Phone:714-778-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4605Medicare ID - Type UnspecifiedMEDICARE ID