Healthcare Provider Details

I. General information

NPI: 1982019212
Provider Name (Legal Business Name): MATTHEW TOMATZ MA, LPC, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 VALMONT RD SUITE 200
BOULDER CO
80301-1361
US

IV. Provider business mailing address

1895 TANSY PL
BOULDER CO
80304-0890
US

V. Phone/Fax

Practice location:
  • Phone: 303-709-5525
  • Fax:
Mailing address:
  • Phone: 303-709-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4385
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number598
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: