MEDICARE: MR. MATT W WOLFF LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	70357	TX
2	101YP2500X	Professional Counselor	LPC014226	GA
3	101YP2500X	Professional Counselor	70357	TX

General Provider Information

NPI Number	:	1407212152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATT W WOLFF LPC

Provider Business Mailing Address
First Line	:	5125 MEADOWBROOK DR
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6415
Country	:	US
Telephone Number	:	903-413-3204
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 MEADOWBROOK DR
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75402-6415
Country	:	US
Telephone Number	:	903-413-3204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2016
Last Update Date	:	12/18/2023

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