Provider Demographics
NPI:1902980964
Name:ALVARADO, MATILDA (LMHC)
Entity Type:Individual
Prefix:
First Name:MATILDA
Middle Name:
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E ALTA VISTA AVE
Mailing Address - Street 2:BEHAVIORAL HEALTH COUNSELING SERVICES
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-1413
Mailing Address - Country:US
Mailing Address - Phone:641-684-3138
Mailing Address - Fax:641-684-3198
Practice Address - Street 1:312 E ALTA VISTA AVE
Practice Address - Street 2:BEHAVIORAL HEALTH COUNSELING SERVICES
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-1413
Practice Address - Country:US
Practice Address - Phone:641-684-3138
Practice Address - Fax:641-684-3198
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI18906Medicare PIN