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NPI Code Detail

MEDICARE: MR. MATTHEW MAYNARD MA, NCC

MEDICARE: MR. MATTHEW MAYNARD MA, NCC
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
1101YP2500XProfessional Counselor
2101YP2500XProfessional Counselor2570WV

General Provider Information

NPI Number : 1750970711
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW MAYNARD MA, NCC
Provider Business Mailing Address
First Line : 33 WALNUT LN
Second Line :
City : HUNTINGTON
State : WV
Zip : 25704-9485
Country : US
Telephone Number : 304-638-1551
Fax Number :
Provider Business Practice Location Address
First Line : 744 4TH AVE STE 2
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-1541
Country : US
Telephone Number : 304-691-0873
Fax Number : 304-955-9057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2021
Last Update Date : 02/26/2024

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