Provider Demographics
NPI:1902179591
Name:FURE, MATTHEW JAMES (LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:FURE
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:P.O. BOX 1177
Mailing Address - Street 2:926 SOUTH 8TH STREET
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-1177
Mailing Address - Country:US
Mailing Address - Phone:920-683-4230
Mailing Address - Fax:920-683-4908
Practice Address - Street 1:926 SOUTH 8TH STREET
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54221-1177
Practice Address - Country:US
Practice Address - Phone:920-683-4272
Practice Address - Fax:920-683-4243
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI907-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor