Provider Demographics
NPI:1629835269
Name:VAN PELT, MATTHEW CORY (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CORY
Last Name:VAN PELT
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 BAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-3507
Mailing Address - Country:US
Mailing Address - Phone:432-270-7227
Mailing Address - Fax:
Practice Address - Street 1:1701 E FM 700 STE C10
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5059
Practice Address - Country:US
Practice Address - Phone:432-201-2745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91476101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health