Provider Demographics
NPI:1801143557
Name:MATOY, TAYA J
Entity type:Individual
Prefix:MS
First Name:TAYA
Middle Name:J
Last Name:MATOY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TAYA
Other - Middle Name:J
Other - Last Name:MATOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,
Mailing Address - Street 1:2915 BASELINE RD
Mailing Address - Street 2:#430
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2321
Mailing Address - Country:US
Mailing Address - Phone:720-323-8224
Mailing Address - Fax:
Practice Address - Street 1:2915 BASELINE RD
Practice Address - Street 2:#430
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2321
Practice Address - Country:US
Practice Address - Phone:720-323-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health