Provider Demographics
NPI:1982058137
Name:DAY, MATILDA (RN, MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:RN, MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 LIBERTY ST NE
Practice Address - Street 2:SUITE 203A
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3682
Practice Address - Country:US
Practice Address - Phone:971-599-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3498101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health