Provider Demographics
NPI:1750277430
Name:JONATHAN MATTICE FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:JONATHAN MATTICE FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MATTICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:719-789-5307
Mailing Address - Street 1:33688 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-7820
Mailing Address - Country:US
Mailing Address - Phone:707-217-3672
Mailing Address - Fax:
Practice Address - Street 1:33688 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-7820
Practice Address - Country:US
Practice Address - Phone:707-217-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)