Individual
JOSE MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1795 JET WING DR, COLORADO SPRINGS, CO 80916-2332
(719) 572-6100
Mailing address
220 RUSKIN DR, COLORADO SPRINGS, CO 80910-2522
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0001671
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09925839
CO
Other
Enumeration date
07/05/2013
Last updated
02/24/2021
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