Provider Demographics
NPI:1740801794
Name:NEWELL, MATTHEW AARON (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:NEWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 LYNHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3028
Mailing Address - Country:US
Mailing Address - Phone:215-594-9818
Mailing Address - Fax:
Practice Address - Street 1:38600 VAN DYKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1171
Practice Address - Country:US
Practice Address - Phone:248-266-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018228101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401018228OtherSTATE LICENSE NUMBER
TX78085OtherSTATE LICENSE NUMBER