Basic Information
| Provider Information | |||||||||
| NPI: | 1588145049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLING | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BARKAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7981 N LIME STAR DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857437337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266239204 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7981 N LIME STAR DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857437337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266239204 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 04/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW83683 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW10168 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW-19518 | AZ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.