Provider Demographics
NPI:1891180063
Name:MONAHAN-REED, MATTHEW R (MA, LPC, BCBA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:MONAHAN-REED
Suffix:
Gender:M
Credentials:MA, LPC, BCBA
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:R
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, BCBA
Mailing Address - Street 1:685 LARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6834
Mailing Address - Country:US
Mailing Address - Phone:616-239-9389
Mailing Address - Fax:
Practice Address - Street 1:790 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1918
Practice Address - Country:US
Practice Address - Phone:616-336-3909
Practice Address - Fax:616-336-8830
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-18-32319103K00000X
MI0-17-7620106E00000X
MI6401224158101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst