Healthcare Provider Details

I. General information

NPI: 1891180063
Provider Name (Legal Business Name): MATTHEW R MONAHAN-REED MA, LPC, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATTHEW R MONAHAN MA, LPC, BCBA

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

685 LARKWOOD DR
HOLLAND MI
49423-6834
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax: 616-336-8830
Mailing address:
  • Phone: 616-239-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32319
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-17-7620
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: