Provider Demographics
NPI:1053054122
Name:TOLLIVER, MATTHEW BRANNON (PHD, LPC, NCC, ALPS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRANNON
Last Name:TOLLIVER
Suffix:
Gender:M
Credentials:PHD, LPC, NCC, ALPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6940
Mailing Address - Country:US
Mailing Address - Phone:304-319-0396
Mailing Address - Fax:
Practice Address - Street 1:711 PARK ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6940
Practice Address - Country:US
Practice Address - Phone:304-319-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health