Provider Demographics
NPI:1376374256
Name:PEIFER, MATTHEW GLEN (MS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GLEN
Last Name:PEIFER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 PIMLICO DR APT 201
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2512
Mailing Address - Country:US
Mailing Address - Phone:901-834-2124
Mailing Address - Fax:
Practice Address - Street 1:152 TIMBER CREEK DR STE 4
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4237
Practice Address - Country:US
Practice Address - Phone:901-498-9126
Practice Address - Fax:901-746-8269
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health