Provider Demographics
NPI:1518679612
Name:GERACIE, MATTHEW PHILLIP (LPC-S)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILLIP
Last Name:GERACIE
Suffix:
Gender:M
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3354
Mailing Address - Country:US
Mailing Address - Phone:303-641-2446
Mailing Address - Fax:
Practice Address - Street 1:1118 PHILIP DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3354
Practice Address - Country:US
Practice Address - Phone:303-641-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health