Healthcare Provider Details

I. General information

NPI: 1134629470
Provider Name (Legal Business Name): MATTHEW D. HALVORSON MA, L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W STASSNEY LN
AUSTIN TX
78745-3401
US

IV. Provider business mailing address

2609 MONARCH DR
AUSTIN TX
78748-5902
US

V. Phone/Fax

Practice location:
  • Phone: 512-469-0889
  • Fax: 512-469-6002
Mailing address:
  • Phone: 512-469-0889
  • Fax: 512-469-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number74971
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.016078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: