Provider Demographics
NPI:1508121278
Name:HEARD, MATTHEW WILLIAM (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:HEARD
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MILL CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9365
Mailing Address - Country:US
Mailing Address - Phone:334-794-5467
Mailing Address - Fax:334-677-1051
Practice Address - Street 1:256 HONEYSUCKLE RD
Practice Address - Street 2:SUITE 14
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1157
Practice Address - Country:US
Practice Address - Phone:334-794-5467
Practice Address - Fax:334-677-1051
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3052101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor