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General NPI Number Information
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NPI Number | 1174381917
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Entity Type | Individual
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Provider Name | MATTHEW L STANLEY LMHC
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Gender | Male
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 205 S WALNUT ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-6128
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Country | US
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Telephone | 812-360-4847
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Fax |
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Provider Business Mailing Address
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Address Line | 645 SAMS HILL RD
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City | NASHVILLE
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State | IN
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Zip | 47448-9685
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Country | US
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Telephone | 812-360-4847
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 99123673A
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License Number State | IN
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