Provider Demographics
NPI:1215584115
Name:ROSENKILDE, MATTHEW (LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:ROSENKILDE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1306
Mailing Address - Country:US
Mailing Address - Phone:480-709-4635
Mailing Address - Fax:480-359-3270
Practice Address - Street 1:54 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1306
Practice Address - Country:US
Practice Address - Phone:480-709-4635
Practice Address - Fax:480-359-3270
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21819101YP2500X, 101Y00000X
AZLAC-17463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor