Active NPI
Edna Mae Mattox, MSW
- Mental Health Counselor
- Gautier, MS
National Provider Identifier
1386947166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 3407 Shamrock CT
Gautier, MS 39553-6429 - Phone
- (228) 497-0690
- Fax
- (228) 497-1363
- NPI assigned
- Dec 16, 2010
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
3407 Shamrock CT
Gautier, MS 39553-6429
Mailing address
3407 Shamrock CT
Gautier, MS 39553-6429
Phone (228) 497-0690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018214 | Medicaid | MS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292457600000",
"number": "1386947166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3407 SHAMROCK CT",
"city": "GAUTIER",
"state": "MS",
"postal_code": "395536429",
"telephone_number": "228-497-0690",
"fax_number": "228-497-1363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3407 SHAMROCK CT",
"city": "GAUTIER",
"state": "MS",
"postal_code": "395536429",
"telephone_number": "228-497-0690",
"fax_number": "228-497-1363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOX",
"first_name": "EDNA",
"middle_name": "MAE",
"name_prefix": "Mrs.",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-16",
"last_updated": "2010-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00018214",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gautier, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.