Provider Demographics
NPI:1538537741
Name:KOOS, MATYAS JOSEPH (LPC, LCDC)
Entity type:Individual
Prefix:MR
First Name:MATYAS
Middle Name:JOSEPH
Last Name:KOOS
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W NORTHWEST HWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8127
Mailing Address - Country:US
Mailing Address - Phone:817-637-7176
Mailing Address - Fax:
Practice Address - Street 1:1701 W NORTHWEST HWY
Practice Address - Street 2:SUITE #100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8127
Practice Address - Country:US
Practice Address - Phone:817-637-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11940101YA0400X
TX71257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)