Provider Demographics
NPI:1790114098
Name:BURYTA, MATTHEW (LLMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BURYTA
Suffix:
Gender:M
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25015 SUPERIOR RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4518
Mailing Address - Country:US
Mailing Address - Phone:734-231-8190
Mailing Address - Fax:
Practice Address - Street 1:696 N MILL ST STE 107
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1280
Practice Address - Country:US
Practice Address - Phone:734-231-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist