Provider Demographics
NPI:1952711921
Name:NAGEL, MATTHEW (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:NAGEL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16265 CONNEAUT LAKE RD
Mailing Address - Street 2:SUITE 1391
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3861
Mailing Address - Country:US
Mailing Address - Phone:814-807-1330
Mailing Address - Fax:814-807-1338
Practice Address - Street 1:16265 CONNEAUT LAKE RD
Practice Address - Street 2:SUITES 1391 AND 1389
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3861
Practice Address - Country:US
Practice Address - Phone:814-336-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional