Provider Demographics
NPI:1356787808
Name:GRAMMER, MATTHEW ALLEN (LPCC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:GRAMMER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 GOLDSMITH LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2006
Mailing Address - Country:US
Mailing Address - Phone:502-252-1865
Mailing Address - Fax:502-631-9660
Practice Address - Street 1:1939 GOLDSMITH LN
Practice Address - Street 2:SUITE 120
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2006
Practice Address - Country:US
Practice Address - Phone:502-252-1865
Practice Address - Fax:502-631-9660
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100343850Medicaid
KY7100342240Medicaid
KY7100397670Medicaid