Provider Demographics
NPI:1982960100
Name:PIERCE, MATT WAYNE
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:WAYNE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 N MAY AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3925
Mailing Address - Country:US
Mailing Address - Phone:405-947-7555
Mailing Address - Fax:580-242-4679
Practice Address - Street 1:5929 N MAY AVE STE 506
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3925
Practice Address - Country:US
Practice Address - Phone:405-947-7555
Practice Address - Fax:580-242-4697
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health