Provider Demographics
NPI:1275697120
Name:MATULE, VINCENT PAUL (MSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:MATULE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S EWING ST
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5938
Mailing Address - Country:US
Mailing Address - Phone:406-442-2914
Mailing Address - Fax:406-442-4192
Practice Address - Street 1:25 S EWING ST
Practice Address - Street 2:SUITE # 204
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5938
Practice Address - Country:US
Practice Address - Phone:406-442-2914
Practice Address - Fax:406-442-4192
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health