Basic Information
| Provider Information | |||||||||
| NPI: | 1982903647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | CLARISSA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PCC, LPCC, LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193346619 | ||||||||
| FaxNumber: | 4193346663 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 S TAFT AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434203237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193346619 | ||||||||
| FaxNumber: | 4193346663 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2011 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | E0500480 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.