Provider Demographics
NPI:1265108047
Name:LUNSFORD, MATTHEW RYAN (MED, MS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BEATSON ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5636
Mailing Address - Country:US
Mailing Address - Phone:540-219-4440
Mailing Address - Fax:
Practice Address - Street 1:2217 PRINCESS ANNE ST STE 215-1
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3351
Practice Address - Country:US
Practice Address - Phone:540-219-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-52050103K00000X
VA0133002098103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst