Healthcare Provider Details

I. General information

NPI: 1801296959
Provider Name (Legal Business Name): MATTHEW WILLIAM ALLISON L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 W WILLOW HWY
LANSING MI
48917-1231
US

IV. Provider business mailing address

6211 W WILLOW HWY
LANSING MI
48917-1231
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-0242
  • Fax:
Mailing address:
  • Phone: 517-321-0242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012232
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: