Provider Demographics
NPI:1285917997
Name:THATCHER, MATTHEW (LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:THATCHER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 WEALTHY ST SE STE 242
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2755
Mailing Address - Country:US
Mailing Address - Phone:616-202-2138
Mailing Address - Fax:616-228-8990
Practice Address - Street 1:333 W WESTERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49440
Practice Address - Country:US
Practice Address - Phone:616-202-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YMO800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health