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General NPI Number Information
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NPI Number | 1922897347
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Entity Type | Individual
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Provider Name | MATTHEW GRAHAM CADC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 19563 LEXINGTON RD
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City | MINBURN
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State | IA
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Zip | 50167-8149
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Country | US
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Telephone | 845-283-8919
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Fax | 845-283-8919
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Provider Business Mailing Address
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Address Line | 211 E COURT AVE
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City | DES MOINES
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State | IA
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Zip | 50309-2012
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Country | US
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Telephone | 845-283-8919
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Fax | 845-283-8919
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 20081
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License Number State | IA
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