Provider Demographics
NPI:1396952131
Name:MATTHEW, NITISH (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:NITISH
Middle Name:
Last Name:MATTHEW
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-3114
Mailing Address - Country:US
Mailing Address - Phone:303-420-8080
Mailing Address - Fax:303-420-9299
Practice Address - Street 1:6700 W 44TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80033-4732
Practice Address - Country:US
Practice Address - Phone:303-420-8080
Practice Address - Fax:303-420-9299
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health