| NPI | 1205416724 |
|---|---|
| Other Name | TREY MATLOCK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024079) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2022-06-08 |