MEDICARE: MR. NITISH MATTHEW MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4408	CO

General Provider Information

NPI Number	:	1396952131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NITISH MATTHEW MA, LPC, NCC

Provider Business Mailing Address
First Line	:	801 LOGAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-3114
Country	:	US
Telephone Number	:	303-420-8080
Fax Number	:	303-420-9299

Provider Business Practice Location Address
First Line	:	6700 W 44TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80033-4732
Country	:	US
Telephone Number	:	303-420-8080
Fax Number	:	303-420-9299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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