Provider Demographics
NPI:1407212152
Name:WOLFF, MATT W (LPC)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:W
Last Name:WOLFF
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 1:5125 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6415
Mailing Address - Country:US
Mailing Address - Phone:903-413-3204
Mailing Address - Fax:
Practice Address - Street 1:5125 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6415
Practice Address - Country:US
Practice Address - Phone:903-413-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70357101YM0800X, 101YP2500X
GALPC014226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health