Individual ProviderMatthew SmithCounselorBehavioral Health & Social Service ProvidersPractice Address10714 NE Glisan St, Portland, OR 97220-4046(503) 256-2453(503) 645-3581PECOS EnrollmentBased on the most recent information from CMS, provider Matthew Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1164878872Provider TypeIndividualFull NameSmith, MatthewTitleMr.GenderMaleSole ProprietorNoEnumeration Date5/11/2016Last Updated5/11/2016Contact InformationPractice LocationPractice Address10714 NE Glisan St, Portland, OR 97220-4046Phone(503) 256-2453FaxUnlisted FaxMailing LocationMailing Address14600 NW Cornell Rd, Portland, OR 97229-5442Phone(503) 645-3581FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted Issuer