Provider Demographics
NPI:1528842994
Name:MATOS, CHRISTINE LYNN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LYNN
Last Name:MATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66361 PINDER PL APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-1329
Mailing Address - Country:US
Mailing Address - Phone:719-238-2728
Mailing Address - Fax:
Practice Address - Street 1:929 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3805
Practice Address - Country:US
Practice Address - Phone:785-390-1599
Practice Address - Fax:785-390-0008
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04470101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional