Provider Demographics
NPI:1497200125
Name:JUNGLAS, MATTHEW (MS, LPC, NCC, CDBT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:JUNGLAS
Suffix:
Gender:M
Credentials:MS, LPC, NCC, CDBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 LEHMAN DR STE 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3415
Mailing Address - Country:US
Mailing Address - Phone:719-439-8013
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR STE 209
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3415
Practice Address - Country:US
Practice Address - Phone:719-439-8013
Practice Address - Fax:719-434-9942
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional