Provider Demographics
NPI:1881896165
Name:TORRES, MATTHEW JAMES (CAC III 5317)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:TORRES
Suffix:
Gender:M
Credentials:CAC III 5317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3035
Mailing Address - Country:US
Mailing Address - Phone:719-845-0913
Mailing Address - Fax:719-846-2276
Practice Address - Street 1:204 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3035
Practice Address - Country:US
Practice Address - Phone:719-845-0913
Practice Address - Fax:719-846-2276
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)