Provider Demographics
NPI:1538752423
Name:MY THERAPY MATTERS LLC
Entity type:Organization
Organization Name:MY THERAPY MATTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-817-0155
Mailing Address - Street 1:1094 S GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5092
Mailing Address - Country:US
Mailing Address - Phone:435-817-0155
Mailing Address - Fax:
Practice Address - Street 1:1834 VINEWOOD LANE
Practice Address - Street 2:STE 217
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2559
Practice Address - Country:US
Practice Address - Phone:719-404-6618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY THERAPY MATTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1811154321Medicaid