Provider Demographics
NPI:1205074176
Name:NYQUIST, MAT F (MS LPC)
Entity type:Individual
Prefix:MR
First Name:MAT
Middle Name:F
Last Name:NYQUIST
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 CHILDS AVE NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7471
Mailing Address - Country:US
Mailing Address - Phone:503-507-5961
Mailing Address - Fax:
Practice Address - Street 1:388 STATE ST # 710
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-507-5961
Practice Address - Fax:503-339-1972
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC 3826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health