Provider Demographics
NPI:1588025183
Name:CRUVANT, MATTHEW (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:CRUVANT
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 ST HELENS AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3706
Mailing Address - Country:US
Mailing Address - Phone:253-274-0484
Mailing Address - Fax:
Practice Address - Street 1:758 ST HELENS AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3706
Practice Address - Country:US
Practice Address - Phone:253-274-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60305802101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health