| Doctor Name: | MRS. JACQUELYN MICHELLE MATOTEK |
| NPI Number: | 1033581368 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A.,NCC, LPC, CCTP |
| License Number: | PC008541 |
| Business Practice Address: | 250 Insurance St Suite 304 Beaver, PA - 150092760 |
| Business Phone Number: | 7243716838 |
| Business Fax Number: | |
| Mailing Address: | 2512 Orchard St, BEAVER FALLS |
| State: | PA |
| Postal Code: | 150102373 |
| Phone Number: | 7246225471 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2015 |
| NPI Last Update Date: | 05/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PC008541 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |