Provider Demographics
NPI:1982700217
Name:MATHIS, STEPHEN M (PSYD, AAPTA)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:MATHIS
Suffix:
Gender:M
Credentials:PSYD, AAPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 N DIVISION AVE STE 207G
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5054
Mailing Address - Country:US
Mailing Address - Phone:208-290-7469
Mailing Address - Fax:
Practice Address - Street 1:1218 N DIVISION AVE STE 207G
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5054
Practice Address - Country:US
Practice Address - Phone:208-290-7469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY203690103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist