Provider Demographics
NPI:1508549494
Name:MATOUSEK, JONATHON PATRICK
Entity Type:Individual
Prefix:MR
First Name:JONATHON
Middle Name:PATRICK
Last Name:MATOUSEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 BUENA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7239
Mailing Address - Country:US
Mailing Address - Phone:530-274-2000
Mailing Address - Fax:
Practice Address - Street 1:256 BUENA VISTA ST STE 100
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7239
Practice Address - Country:US
Practice Address - Phone:530-274-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)