Active NPI
Susan Oleta Mattocks, PSY.D.
- Clinical Psychologist
- Miles City, MT
National Provider Identifier
1417039918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 363
- Practice address
- 2600 Wilson St
Suite 2
Miles City, MT 59301-5094 - Phone
- (406) 233-4219
- Fax
- (406) 233-2503
- NPI assigned
- Oct 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 363 | MT | Primary |
Addresses
Primary practice location
2600 Wilson St
Suite 2
Miles City, MT 59301-5094
Mailing address
2600 Wilson St
Suite 2
Miles City, MT 59301-5094
Phone (406) 233-4219
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 363 | MT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1417039918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 WILSON ST",
"address_2": "SUITE 2",
"city": "MILES CITY",
"state": "MT",
"postal_code": "593015094",
"telephone_number": "406-233-4219",
"fax_number": "406-233-2503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 WILSON ST",
"address_2": "SUITE 2",
"city": "MILES CITY",
"state": "MT",
"postal_code": "593015094",
"telephone_number": "406-233-4219",
"fax_number": "406-233-2503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOCKS",
"first_name": "SUSAN",
"middle_name": "OLETA",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MT",
"license": "363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miles City, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.