Provider Demographics
NPI:1023664976
Name:COY, MATTHEW DAVID
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:COY
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 1:296 STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1171
Mailing Address - Country:US
Mailing Address - Phone:740-222-4882
Mailing Address - Fax:
Practice Address - Street 1:145 MORRIS RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1363
Practice Address - Country:US
Practice Address - Phone:740-474-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor