Active NPI
Breyonna Mathis
- School Psychologist
- Toledo, OH
National Provider Identifier
1104285295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- OH3134812
- Practice address
- 2417 Cass Road
Toledo, OH 43614 - Phone
- (419) 671-8855
- NPI assigned
- Feb 17, 2016
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | OH3134812 | OH | Primary |
Addresses
Primary practice location
2417 Cass Road
Toledo, OH 43614
Mailing address
2021 Key St Apt L
Maumee, OH 43537-2521
Phone (419) 260-4787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OH3134812 | OH | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1104285295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2021 KEY ST APT L",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435372521",
"telephone_number": "419-260-4787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2417 CASS ROAD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "43614",
"telephone_number": "419-671-8855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "BREYONNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-17",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "OH",
"license": "OH3134812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.