Matthew W Ditslear, LMFT
Counselor, Mental Health in Port Orange, FL. Individual provider (NPI-1).
NPI number1508538729
StatusActive
Last updated in NPPESOct 5, 2021
Details
- NPI
- 1508538729
- Entity type
- Individual (NPI-1)
- Name
- Matthew W Ditslear
- Credential
- LMFT
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 5, 2021
- Certification date
- Oct 5, 2021
- Last updated
- Oct 5, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | 2754 | FL | Yes |
Practice location
520 Sun Lake DrPort Orange, FL 32127-1129
Phone 904-536-0709
Mailing address
520 Sun Lake DrPort Orange, FL 32127-1129
Phone 190-453-6070
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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