Jenny M Matthai, ED.D

Key facts

NPI

1043392269

Entity type

Individual (NPI type 1)

Primary specialty

Psychologist 103T00000X

License

P1753 (TN)

Practice address

571 Watsonwood Dr
Nashville, TN 37211-5320

Phone

(615) 604-7000

NPI assigned

Oct 19, 2006

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2011.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308873600000",
    "number": "1043392269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "571 WATSONWOOD DRIVE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "37211",
            "telephone_number": "615-604-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 WATSONWOOD DR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372115320",
            "telephone_number": "615-604-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHAI",
        "first_name": "JENNY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "ED.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "HSP 1753",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P1753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - NONPARTICIPATING",
            "identifier": "4070500",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3983054",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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