Provider Demographics
NPI:1336431998
Name:MATHIS, LYNDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 BASELINE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2367
Mailing Address - Country:US
Mailing Address - Phone:303-200-0795
Mailing Address - Fax:
Practice Address - Street 1:2935 BASELINE RD STE 303
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2367
Practice Address - Country:US
Practice Address - Phone:303-200-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30744103TC0700X
COPSY.0005018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical