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General NPI Number Information
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NPI Number | 1548925472
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Entity Type | Individual
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Provider Name | MATTHEW E. DYER LPC
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Gender | Male
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/05/2021
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Provider Practice Location Address
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Address Line | 6635 W HAPPY VALLEY RD STE A104-252
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City | GLENDALE
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State | AZ
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Zip | 85310-2609
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Country | US
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Telephone | 910-478-6615
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Fax |
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Provider Business Mailing Address
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Address Line | 6635 W HAPPY VALLEY RD STE A104-252
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City | GLENDALE
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State | AZ
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Zip | 85310-2609
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Country | US
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Telephone | 910-478-6615
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 20001
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License Number State | AZ
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