Davis, Matthew Tyler

Davis, Matthew Tyler is an individual health care provider with primary practice located at 801 Master St Ste 2 , Corbin KY 40701-1026. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Davis, Matthew Tyler can be contacted via phone (606) 215-3695.

Contact Information

Primary practice address
801 Master St Ste 2 Corbin KY 40701-1026
Phone: (606) 215-3695
Fax: (606) 215-3695
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 271738 Kentucky
Behavioral Health & Social Service Providers / Clinical 103TC0700X 281597 Kentucky

Profile Details

NPI number 1356010862
LBN Legal business name Davis, Matthew Tyler
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 8th, 2021
Last updated Jan 2nd, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356010862 NPPES
Kentucky Other 281597 LICENSE NUMBER
Kentucky MEDICAID 7100773860 LICENSE NUMBER

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