Healthcare Provider Details

I. General information

NPI: 1740702034
Provider Name (Legal Business Name): MATTHEW ISHLER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2017
Last Update Date: 07/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S. ALLEN STREET STE 326
STATE COLLEGE PA
16801
US

IV. Provider business mailing address

315 S. ALLEN STREET STE 326
STATE COLLEGE PA
16801
US

V. Phone/Fax

Practice location:
  • Phone: 814-308-0704
  • Fax:
Mailing address:
  • Phone: 814-308-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005765
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: