Provider Demographics
NPI:1295037315
Name:SEVERSON, MATTHEW T
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:T
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W VIRGINIA ST
Mailing Address - Street 2:STE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1500
Mailing Address - Country:US
Mailing Address - Phone:414-831-4500
Mailing Address - Fax:414-255-3451
Practice Address - Street 1:600 W VIRGINIA ST
Practice Address - Street 2:STE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1500
Practice Address - Country:US
Practice Address - Phone:414-831-4500
Practice Address - Fax:414-255-3451
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor