Provider Demographics
NPI:1538811336
Name:KIZAUR, MATTHEW WILLIAM (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:KIZAUR
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 MEADOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3137
Mailing Address - Country:US
Mailing Address - Phone:419-367-9646
Mailing Address - Fax:
Practice Address - Street 1:2532 MEADOWWOOD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3137
Practice Address - Country:US
Practice Address - Phone:419-367-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2203990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health