| Doctor Name: | DR. SUSAN OLETA MATTOCKS |
| NPI Number: | 1417039918 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 363 |
| Business Practice Address: | 2600 Wilson St Suite 2 Miles City, MT - 593015094 |
| Business Phone Number: | 4062334219 |
| Business Fax Number: | 4062332503 |
| Mailing Address: | 2600 Wilson St, Suite 2 MILES CITY |
| State: | MT |
| Postal Code: | 593015094 |
| Phone Number: | 4062334219 |
| Fax Number: | 4062332503 |
| NPI Enumeration Date: | 10/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 363 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |