Provider Demographics
NPI:1255921995
Name:MY THERAPY MATTERS
Entity type:Organization
Organization Name:MY THERAPY MATTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-817-0155
Mailing Address - Street 1:1094 S GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-5092
Mailing Address - Country:US
Mailing Address - Phone:435-817-0155
Mailing Address - Fax:
Practice Address - Street 1:19 E ABARR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-5436
Practice Address - Country:US
Practice Address - Phone:435-817-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48800074Medicaid