MEDICARE: MR. MATTHEW TAYLOR MA, LPC, NCC, LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	110473	OH

General Provider Information

NPI Number	:	1952659013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW TAYLOR MA, LPC, NCC, LICDC

Provider Business Mailing Address
First Line	:	87 CONSERVATORY DR
Second Line	:
City	:	BARBERTON
State	:	OH
Zip	:	44203-4291
Country	:	US
Telephone Number	:	234-334-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 CONSERVATORY DR
Second Line	:
City	:	BARBERTON
State	:	OH
Zip	:	44203-4291
Country	:	US
Telephone Number	:	234-334-0303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	06/21/2019

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