Provider Demographics
NPI:1831697432
Name:MYATT, MATTHEW CARTER (LPC-MHSP)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CARTER
Last Name:MYATT
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 N MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2654
Mailing Address - Country:US
Mailing Address - Phone:901-286-4017
Mailing Address - Fax:901-234-0007
Practice Address - Street 1:165 N MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2654
Practice Address - Country:US
Practice Address - Phone:901-286-4017
Practice Address - Fax:901-234-0007
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4007101Y00000X
TN4007101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor