Provider Demographics
NPI:1801333497
Name:MATZ, CHARLES (MS MFT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MATZ
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 STRUCK ST
Mailing Address - Street 2:45031
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53744-3601
Mailing Address - Country:US
Mailing Address - Phone:608-577-6289
Mailing Address - Fax:
Practice Address - Street 1:733 STRUCK ST
Practice Address - Street 2:45031
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53744-3601
Practice Address - Country:US
Practice Address - Phone:608-577-6289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI519-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist