MEDICARE: MS. LAUREN MATOS LMHC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	MH12696	FL
2	101YP2500X	Professional Counselor	MH12696	FL
3	101YM0800X	Mental Health Counselor	MH12696	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265849368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN MATOS LMHC

Provider Business Mailing Address
First Line	:	2727 W DR MLK BLVD STE 640
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6399
Country	:	US
Telephone Number	:	813-772-7582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2727 W DR MARTIN LUTHER KING JR BLVD STE 640
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6399
Country	:	US
Telephone Number	:	813-872-7582
Fax Number	:

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	10/21/2024

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