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General NPI Number Information
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NPI Number | 1427685148
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Entity Type | Organization
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Legal Business Name | MATTHEW WADDELL CONSULTING LLC
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 103 E LIBERTY ST STE 203
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City | ANN ARBOR
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State | MI
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Zip | 48104-2136
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Country | US
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Telephone | 734-210-1187
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 KINGWOOD ST
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City | YPSILANTI
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State | MI
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Zip | 48197-2008
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Country | US
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Telephone | 810-410-5583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW WADDELL
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Credential | LMSW
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Telephone | 734-210-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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