Provider Demographics
NPI:1871975409
Name:MATTLE, ANDREW (LMHC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MATTLE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2398
Mailing Address - Country:US
Mailing Address - Phone:716-847-0212
Mailing Address - Fax:716-847-0418
Practice Address - Street 1:206 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2398
Practice Address - Country:US
Practice Address - Phone:716-847-0212
Practice Address - Fax:716-847-0418
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001957-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001957OtherLMHC