Basic Information
| Provider Information | |||||||||
| NPI: | 1376138529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEAZER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | STYLES | ||||||||
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| Credential: | LCMHC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 TUNNEL ROAD, SUITE D | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288054504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284601541 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 119 TUNNEL ROAD, SUITE D | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283501000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2021 | ||||||||
| LastUpdateDate: | 03/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A16394 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.