Provider Demographics
NPI:1306184494
Name:KORSTJENS, MATTHEW RYAN (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:KORSTJENS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 N ANN ARBOR AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-3728
Mailing Address - Country:US
Mailing Address - Phone:405-317-9562
Mailing Address - Fax:
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1549
Practice Address - Country:US
Practice Address - Phone:405-242-2969
Practice Address - Fax:405-421-0818
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health