Individual
MR. MATTHEW JOHN DEETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
741 N 1ST ST, WAUSAU, WI 54403-4721
(715) 675-3458
(715) 675-7238
Mailing address
PO BOX 118, WAUSAU, WI 54402-0118
(715) 675-3458
(715) 675-7238
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1801-226
WI
101YP2500X
Professional Counselor
Primary
5814-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801-226
STATE LICENSE
WI
01
—
5814-125
STATE LICENSE
WI
Enumeration date
12/29/2014
Last updated
11/04/2015
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