Provider Demographics
NPI:1548611577
Name:VOGT, MATTHEW (CACII)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:VOGT
Suffix:
Gender:M
Credentials:CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 32 1/2 RD
Mailing Address - Street 2:#94
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-8906
Mailing Address - Country:US
Mailing Address - Phone:970-778-6215
Mailing Address - Fax:
Practice Address - Street 1:1105 UTE AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3652
Practice Address - Country:US
Practice Address - Phone:970-778-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB.0007830101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)