Healthcare Provider Details

I. General information

NPI: 1962829929
Provider Name (Legal Business Name): MATTHEW EVERETT RIMER LPC, CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

IV. Provider business mailing address

16535 W BLUEMOUND RD STE 200
BROOKFIELD WI
53005-5906
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax: 262-821-6180
Mailing address:
  • Phone: 262-789-1191
  • Fax: 262-821-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16109
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7144-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: