1750277430 NPI number — JONATHAN MATTICE FAMILY THERAPY CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750277430 NPI number — JONATHAN MATTICE FAMILY THERAPY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONATHAN MATTICE FAMILY THERAPY CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750277430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33688 VALLEY VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80439-7820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-217-3672
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33688 VALLEY VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80439-7820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-217-3672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MATTICE
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
MARRIAGE AND FAMILY THERAPIST
Authorized Official Telephone Number:
719-789-5307

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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