MEDICARE: MR. MATTHEW M. PAYMAR M.A., LPCC

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	CC00275	MN

General Provider Information

NPI Number	:	1568761807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW M. PAYMAR M.A., LPCC

Provider Business Mailing Address
First Line	:	5871 CEDAR LAKE RD S STE 220
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3804
Country	:	US
Telephone Number	:	612-293-9332
Fax Number	:	267-363-2411

Provider Business Practice Location Address
First Line	:	5871 CEDAR LAKE RD S STE 220
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-3804
Country	:	US
Telephone Number	:	612-293-9332
Fax Number	:	267-363-2411

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	03/25/2011

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