Basic Information
| Provider Information | |||||||||
| NPI: | 1891180063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONAHAN-REED | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MA, LLPC, BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MONAHAN | ||||||||
| OtherFirstName: | MATTHEW | ||||||||
| OtherMiddleName: | R | ||||||||
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| OtherCredential: | MA, LLPC, BCBA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 531 ALICE AVE | ||||||||
| Address2: | |||||||||
| City: | ZEELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494641433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162399389 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 715 TERRACE ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318309376 | ||||||||
| FaxNumber: | 2317371464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401014369 | MI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106E00000X | 0-17-7620 | MI | N | 103K00000X | 1-18-32319 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.