Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Matthew Nicholas Otto, TCADC

Individual provider Counselor · NPI 1053907634

Matthew Nicholas Otto, TCADC is a Mental Health Counselor in Lexington, Kentucky. Qualified in 2024, 2 years ago. Practices with Roaring Brook LLC, a 4-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
2
Licensed in
KY
In the registry since
2020
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Practice location Address checks out

600 Perimeter Dr Ste 125
Lexington, KY 40517-4296
Phone: (866) 678-8123
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Counselor (primary) Taxonomy 101Y00000X · Licence 290511 (KY)

Record details

NPI number1053907634
Entity typeIndividual (Type 1)
GenderMale
Credentials TCADC
Sole proprietorNo
NPI enumeratedDecember 17, 2020
Last updated in NPPESJune 24, 2024
Certification dateJune 24, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Roaring Brook Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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