Provider Demographics
NPI:1720324106
Name:MATA, ELISELDA (LPC, CAC III)
Entity type:Individual
Prefix:
First Name:ELISELDA
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 S PARKER RD STE 410
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2725
Mailing Address - Country:US
Mailing Address - Phone:720-524-6874
Mailing Address - Fax:
Practice Address - Street 1:2204 N EMERSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5127
Practice Address - Country:US
Practice Address - Phone:970-424-4061
Practice Address - Fax:872-766-0965
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15407101YP2500X
CO7115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)