Basic Information
| Provider Information | |||||||||
| NPI: | 1881217222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTOX | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | THOMPSON | ||||||||
| OtherFirstName: | LIBBY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 560 SYLVAN AVENUE | ||||||||
| Address2: | SUITE 1110 | ||||||||
| City: | ENGLEWOOD CLIFFS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076323171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6468736600 | ||||||||
| FaxNumber: | 6468594440 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 ALDERSGATE RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018602120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 02/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 103K00000X | 1-21-57077 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.