Healthcare Provider Details

I. General information

NPI: 1356787808
Provider Name (Legal Business Name): MATTHEW ALLEN GRAMMER LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 GOLDSMITH LN SUITE 120
LOUISVILLE KY
40218-2006
US

IV. Provider business mailing address

1939 GOLDSMITH LN SUITE 120
LOUISVILLE KY
40218-2006
US

V. Phone/Fax

Practice location:
  • Phone: 502-252-1865
  • Fax: 502-631-9660
Mailing address:
  • Phone: 502-252-1865
  • Fax: 502-631-9660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: