Provider Demographics
NPI:1699041277
Name:RIGGLE, MATTHEW RICHARD (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:RIGGLE
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 1:4255 S MILL CREEK EST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-8306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5233 SOUTH 50 EAST
Practice Address - Street 2:WHITE'S RESIDENTIAL AND FAMILY SERVICES
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-1158
Practice Address - Fax:260-563-8975
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002309A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health