Provider Demographics
NPI:1265925440
Name:MATT, ABIGAIL (MA, LPC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MATT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 BIRCH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6240
Mailing Address - Country:US
Mailing Address - Phone:317-440-1010
Mailing Address - Fax:
Practice Address - Street 1:1160 BIRCH ST APT 12
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6240
Practice Address - Country:US
Practice Address - Phone:317-440-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019483101YM0800X
RBT-18-57793106S00000X
LPC.0020764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician