Provider Demographics
NPI:1316345713
Name:MATHIA, TIMOTHY EUGENE (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:MATHIA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14812 NW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-5135
Mailing Address - Country:US
Mailing Address - Phone:434-941-8547
Mailing Address - Fax:
Practice Address - Street 1:14812 NW 72ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-5135
Practice Address - Country:US
Practice Address - Phone:434-941-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015036009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional