Basic Information
| Provider Information | |||||||||
| NPI: | 1376851774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATSUI | ||||||||
| FirstName: | NANAMI | ||||||||
| MiddleName: | LINA | ||||||||
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| Credential: | LPC, NCC | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SCOTT | ||||||||
| OtherFirstName: | NANAMI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 715 HORIZON DR STE 225 | ||||||||
| Address2: | |||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815068743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706837035 | ||||||||
| FaxNumber: | 9706837167 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 E LIONSHEAD CIR | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816575354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9704760930 | ||||||||
| FaxNumber: | 9704760535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ACD.0000374 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | LPC.0011245 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.