Active NPI
Michelle R Matzke, PSYD
- Psychologist
- Powell, WY
National Provider Identifier
1073790416
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1953
- Practice address
- 227 N Bent St Ste K
Powell, WY 82435-2335 - Phone
- (406) 219-1477
- Fax
- (888) 929-8661
- NPI assigned
- Jan 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 750 | WY | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 6919 | OH | |
| Psychologist | 103T00000X | 1953 | MT | Primary |
Addresses
Primary practice location
227 N Bent St Ste K
Powell, WY 82435-2335
Mailing address
PO Box 1200
Powell, WY 82435-1200
Phone (406) 219-1477
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2022 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1953 | MT | MD | Psychologist |
| 6919 | OH | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sara Boilen, PSYD, PLLC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Whitefish, MT
- NPI 1821692203
Psychologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1073790416",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1200",
"city": "POWELL",
"state": "WY",
"postal_code": "824351200",
"telephone_number": "406-219-1477",
"fax_number": "888-929-8661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "227 N BENT ST STE K",
"city": "POWELL",
"state": "WY",
"postal_code": "824352335",
"telephone_number": "406-219-1477",
"fax_number": "888-929-8661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATZKE",
"first_name": "MICHELLE",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-29",
"last_updated": "2024-10-29",
"certification_date": "2024-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WY",
"license": "750",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OH",
"license": "6919",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MT",
"license": "1953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Powell, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.