| Doctor Name: | DR. JASON FORREST MATHERS |
| NPI Number: | 1205914173 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D., LPC |
| License Number: | 2001014823 |
| Business Practice Address: | 119 Clarkson Executive Park Ellisville, MO - 630112176 |
| Business Phone Number: | 6362560600 |
| Business Fax Number: | 6362560626 |
| Mailing Address: | 119 Clarkson Executive Park, ELLISVILLE |
| State: | MO |
| Postal Code: | 630112176 |
| Phone Number: | 6362560600 |
| Fax Number: | 6362560626 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2001014823 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |