Provider Demographics
NPI:1750970711
Name:MAYNARD, MATTHEW (MA, NCC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-9485
Mailing Address - Country:US
Mailing Address - Phone:304-638-1551
Mailing Address - Fax:
Practice Address - Street 1:744 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1541
Practice Address - Country:US
Practice Address - Phone:304-691-0873
Practice Address - Fax:304-955-9057
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WV2570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional