Basic Information
Provider Information
NPI: 1003150780
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: MATTHEW
MiddleName: PAUL
NamePrefix: MR.
NameSuffix:  
Credential: PH.D., LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9662 GRETNA GREEN DR
Address2:  
City: TAMPA
State: FL
PostalCode: 336265310
CountryCode: US
TelephoneNumber: 5703513193
FaxNumber:  
Practice Location
Address1: 2909 W BAY TO BAY BLVD STE 200
Address2:  
City: TAMPA
State: FL
PostalCode: 336298175
CountryCode: US
TelephoneNumber: 8133815200
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/19/2012
LastUpdateDate: 10/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XMH15545FLY Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X9782NCN Behavioral Health & Social Service ProvidersCounselorProfessional
101YP2500XPC006435PAN Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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