Provider Demographics
NPI:1801965512
Name:MONCADO, MATTHEW JOSEPH (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:MONCADO
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MO
Mailing Address - Zip Code:65617-0617
Mailing Address - Country:US
Mailing Address - Phone:417-376-2238
Mailing Address - Fax:417-376-2014
Practice Address - Street 1:5549 N HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MO
Practice Address - Zip Code:65617-8112
Practice Address - Country:US
Practice Address - Phone:417-376-2238
Practice Address - Fax:417-376-2014
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO495906406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495906406Medicaid