Provider Demographics
NPI:1306376272
Name:STACH, MATTHEW A (LMHCA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:STACH
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 TIMBERBROOK RUN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9529
Mailing Address - Country:US
Mailing Address - Phone:317-840-1960
Mailing Address - Fax:
Practice Address - Street 1:1212 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-9278
Practice Address - Country:US
Practice Address - Phone:317-316-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000201A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health