Matrix Human Services

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301088119 Issued in MI

Legal business name

MATRIX HUMAN SERVICES

Practice address

120 Parsons St
Detroit, MI 48201-2002

Phone

(313) 831-1000

NPI assigned

May 19, 2014

Last updated

Apr 29, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marcella Wilson, PH.D.

Title

Chief Executive Officer

Phone

(313) 831-1000

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Tax ID family

Matrix Human Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Matrix Human Services

  • In Home Supportive Care Agency
  • Detroit, MI
  • NPI 1821325176
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michelle McCallister, LMSW

  • Clinical Social Worker
  • Ferndale, MI
  • NPI 1346509932
  Medicare reassignment NPD
• Jewell Brockington

  • Community Health Worker
  • Ferndale, MI
  • NPI 1174386742
  NPD (past)
• Cameron Santangelo

  • Community Health Worker
  • Ferndale, MI
  • NPI 1336038777
  NPD (past)
• Satrise Tillman

  • Community Health Worker
  • Ferndale, MI
  • NPI 1285212795
  NPD (past)
• Donella Welton

  • Community Health Worker
  • Ferndale, MI
  • NPI 1154172450
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1073924585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PARSONS ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012002",
            "telephone_number": "313-831-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PARSONS ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012002",
            "telephone_number": "313-831-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARCELLA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "313-831-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301088119",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donnetta Mathis
• Karan Mathur, M.D.
• Tasnia Matin, MD
• Sharon Lynn Matkosky, NP
• Tamika L. Matlock, BSW, LPC
• Matrix Human Services
• Matrix Human Services
• Shawnese Danielle Matsey
• Jennifer Matson
• Shingo Matsubara, ATC

• Psychiatry Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.