Provider Demographics
NPI:1033749908
Name:MATIAS INC
Entity Type:Organization
Organization Name:MATIAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REINALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-916-0239
Mailing Address - Street 1:1400 LAKE SHORE DR STOP 8
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2037
Mailing Address - Country:US
Mailing Address - Phone:219-221-2375
Mailing Address - Fax:219-809-9198
Practice Address - Street 1:1000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4374
Practice Address - Country:US
Practice Address - Phone:219-916-0239
Practice Address - Fax:219-809-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty