Provider Demographics
NPI:1962221200
Name:HEYDON, MATTHEW ALLEN (LPC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALLEN
Last Name:HEYDON
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 1:8029 E JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4341
Mailing Address - Country:US
Mailing Address - Phone:480-825-8721
Mailing Address - Fax:
Practice Address - Street 1:8029 E JUANITA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4341
Practice Address - Country:US
Practice Address - Phone:480-825-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22621101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor