Provider Demographics
NPI:1316340896
Name:BROUS, MATTHEW (LCPC, LCAC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:BROUS
Suffix:
Gender:M
Credentials:LCPC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 HALL ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1964
Mailing Address - Country:US
Mailing Address - Phone:785-269-1011
Mailing Address - Fax:
Practice Address - Street 1:2703 HALL ST STE 5
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1964
Practice Address - Country:US
Practice Address - Phone:785-269-1011
Practice Address - Fax:785-329-4512
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS326101YA0400X
KS2313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid