Provider Demographics
NPI:1063531184
Name:JIRAUCH, MATTHEW (LCSW, CSACII)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:JIRAUCH
Suffix:
Gender:M
Credentials:LCSW, CSACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 FEE FEE RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3801
Mailing Address - Country:US
Mailing Address - Phone:314-275-7600
Mailing Address - Fax:314-275-8486
Practice Address - Street 1:909 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3801
Practice Address - Country:US
Practice Address - Phone:314-275-7600
Practice Address - Fax:314-275-8486
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1951101YA0400X
MO0022271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1951OtherCERTIFIED SUBSTANCE ABUSE