Provider Demographics
NPI:1144191206
Name:EVERETT, MATTHEW W (LLMSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:EVERETT
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 N 32ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8570
Mailing Address - Country:US
Mailing Address - Phone:269-861-1931
Mailing Address - Fax:888-375-5837
Practice Address - Street 1:8599 N 32ND ST STE 102
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8570
Practice Address - Country:US
Practice Address - Phone:269-861-1931
Practice Address - Fax:888-375-5837
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511210121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical