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General NPI Number Information
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NPI Number | 1265741672
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Entity Type | Individual
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Provider Name | ANGELA ROSE MATTA LCSW, LAC
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Gender | Female
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Dates
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Enumeration Date | 10/03/2010
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Last Update Date | 10/03/2010
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Provider Practice Location Address
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Address Line | 208 N BROADWAY STE 423
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City | BILLINGS
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State | MT
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Zip | 59101-1943
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Country | US
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Telephone | 406-896-8427
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Fax |
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Provider Business Mailing Address
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Address Line | 3516 54TH ST W
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City | BILLINGS
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State | MT
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Zip | 59106-1044
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Country | US
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Telephone | 406-208-8959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1202
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 874
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License Number State | MT
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