Provider Demographics
NPI:1205996469
Name:DUCKETT, MATTHEW IVAN (LMFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:IVAN
Last Name:DUCKETT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N SHERMAN ST
Mailing Address - Street 2:#306
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2816
Mailing Address - Country:US
Mailing Address - Phone:720-636-6283
Mailing Address - Fax:
Practice Address - Street 1:15001 E OXFORD AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4191
Practice Address - Country:US
Practice Address - Phone:720-808-0991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49501106H00000X
COMFT.0001216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43023878Medicaid