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General NPI Number Information
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NPI Number | 1285917997
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Entity Type | Individual
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Provider Name | MATTHEW THATCHER L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 333 W WESTERN AVE STE 5
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City | MUSKEGON
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State | MI
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Zip | 49440
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Country | US
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Telephone | 616-202-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 WEALTHY ST SE STE 242
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2755
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Country | US
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Telephone | 616-202-2138
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Fax | 616-228-8990
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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 | 101YMO800X
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License Number State | IL
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