Healthcare Provider Details

I. General information

NPI: 1750277430
Provider Name (Legal Business Name): JONATHAN MATTICE FAMILY THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33688 VALLEY VIEW DR
EVERGREEN CO
80439-7820
US

IV. Provider business mailing address

33688 VALLEY VIEW DR
EVERGREEN CO
80439-7820
US

V. Phone/Fax

Practice location:
  • Phone: 707-217-3672
  • Fax:
Mailing address:
  • Phone: 707-217-3672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JONATHAN DAVID MATTICE
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 719-789-5307