Healthcare Provider Details

I. General information

NPI: 1598504060
Provider Name (Legal Business Name): MATT GIVENS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 AIRPORT NORTH OFFICE PARK
FORT WAYNE IN
46825-6702
US

IV. Provider business mailing address

237 AIRPORT NORTH OFFICE PARK
FORT WAYNE IN
46825-6702
US

V. Phone/Fax

Practice location:
  • Phone: 260-413-7333
  • Fax:
Mailing address:
  • Phone: 260-413-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MATT RYAN GIVENS
Title or Position: OWNER
Credential: LMFT
Phone: 260-413-7333