Provider Demographics
NPI:1699929174
Name:MATHIS, THEODORE IRVING (BSCHE)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:IRVING
Last Name:MATHIS
Suffix:
Gender:M
Credentials:BSCHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8893 TAPPY TOORIE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2244
Mailing Address - Country:US
Mailing Address - Phone:303-791-7917
Mailing Address - Fax:
Practice Address - Street 1:8893 TAPPY TOORIE CIR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2244
Practice Address - Country:US
Practice Address - Phone:303-791-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health