Provider Demographics
NPI:1932566643
Name:MCNIVEN, MATTHEW JAY (MS LPC-860)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAY
Last Name:MCNIVEN
Suffix:
Gender:M
Credentials:MS LPC-860
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3928 ROAD 9
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82411-9731
Mailing Address - Country:US
Mailing Address - Phone:307-272-9224
Mailing Address - Fax:307-762-3715
Practice Address - Street 1:3928 ROAD 9
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WY
Practice Address - Zip Code:82411-9731
Practice Address - Country:US
Practice Address - Phone:307-272-9224
Practice Address - Fax:307-762-3715
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-860101YP2500X
WYSTANDARD101YS0200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool