Provider Demographics
NPI:1568761807
Name:PAYMAR, MATTHEW M (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:M
Last Name:PAYMAR
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 CEDAR LAKE RD S STE 220
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3804
Mailing Address - Country:US
Mailing Address - Phone:612-293-9332
Mailing Address - Fax:267-363-2411
Practice Address - Street 1:5871 CEDAR LAKE RD S STE 220
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-3804
Practice Address - Country:US
Practice Address - Phone:612-293-9332
Practice Address - Fax:267-363-2411
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health