=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700180866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. MATHIAS XAVIER CONE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2011
-----------------------------------------------------
Last Update Date | 11/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 HANOVER LN STE B
-----------------------------------------------------
City | CHICO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95973-7267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-487-1342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13562 SALINAS ST
-----------------------------------------------------
City | LA GRANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95329-9458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-770-0403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------