Provider Demographics
NPI:1780171595
Name:GRIGGS, MATHEW TYLER (LMHA)
Entity type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:TYLER
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:LMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MEDICAL DR, CARMEL, IN 46032
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:176-743-1603
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL DR, CARMEL, IN 46032
Practice Address - Street 2:SUITE D
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-674-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001271A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health