NPI |
1164849139 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Entity Type Code |
2 |
Other last name by which the provider being identified is or has been known. |
Employer Identification Number EIN |
|
Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider first name’’ if the provider is or has been known by a different last name only. |
Provider Organization Name Legal Business Name |
ANGELA MATTA, LCSW, LAC, PC |
Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the ‘‘Provider middle name’’ if the provider
is or has been known by a different last name only. |
Provider First Line Business Practice Location Address |
1925 GRAND AVE STE 123 |
The other abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Business Practice Location Address City Name |
BILLINGS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
591022763 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
4069695930 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Enumeration Date |
3/27/2014 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
3/27/2014 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
MATTA |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
ANGELA |
The first name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT |
The code designating the provider’s gender if the provider is a person. |
Authorized Official Telephone Number |
4069695930 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Taxonomy Code 1 |
251S00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number 1 |
874 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
MT |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Is Organization Subpart |
N |
|
Authorized Official Credential Text |
LCSW, LAC |
|