Provider Demographics
NPI:1144307356
Name:KALATSKY, MATTHEW MARTIN (MA LPC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MARTIN
Last Name:KALATSKY
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23131 N 90TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8342
Mailing Address - Country:US
Mailing Address - Phone:480-236-0712
Mailing Address - Fax:
Practice Address - Street 1:9070 E DESERT COVE DR
Practice Address - Street 2:#A103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6227
Practice Address - Country:US
Practice Address - Phone:480-236-0712
Practice Address - Fax:480-946-4999
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health