Provider Demographics
NPI:1861202483
Name:MATAS MENTAL HEALTH & WELLNESS SERVICES
Entity type:Organization
Organization Name:MATAS MENTAL HEALTH & WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MATAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:704-495-2396
Mailing Address - Street 1:1900 WEEPING WILLOW DR APT G
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3966
Mailing Address - Country:US
Mailing Address - Phone:704-495-2396
Mailing Address - Fax:
Practice Address - Street 1:1900 WEEPING WILLOW DR APT G
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-3966
Practice Address - Country:US
Practice Address - Phone:704-495-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty