Basic Information
| Provider Information | |||||||||
| NPI: | 1962829929 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIMER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | EVERETT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC, CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16535 W BLUEMOUND RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530055906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627891191 | ||||||||
| FaxNumber: | 2628216180 | ||||||||
| Practice Location | |||||||||
| Address1: | 16535 W BLUEMOUND RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530055906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627891191 | ||||||||
| FaxNumber: | 2628216180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2014 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 16109 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 7144-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.