Provider Demographics
NPI:1154667137
Name:RUPERT, MATTHEW THOMAS (LPCC-S, LICDC-CS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:RUPERT
Suffix:
Gender:M
Credentials:LPCC-S, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OVERBROOK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-3100
Mailing Address - Country:US
Mailing Address - Phone:513-539-5250
Mailing Address - Fax:513-539-5371
Practice Address - Street 1:30 OVERBROOK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-3100
Practice Address - Country:US
Practice Address - Phone:513-539-5250
Practice Address - Fax:513-539-5371
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0701155-SUPV101Y00000X
OHICDC.081029101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)