Provider Demographics
NPI:1609001684
Name:MATT 25 INC.
Entity Type:Organization
Organization Name:MATT 25 INC.
Other - Org Name:LIFE SKILLS LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESHETAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-763-4400
Mailing Address - Street 1:1200 THORNTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5508
Mailing Address - Country:US
Mailing Address - Phone:575-763-4400
Mailing Address - Fax:575-935-0400
Practice Address - Street 1:1200 THORNTON ST STE A
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5508
Practice Address - Country:US
Practice Address - Phone:575-763-4400
Practice Address - Fax:575-935-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0153271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty