Active NPI
Lynda Mathis, PH.D.
- Clinical Psychologist
- Boulder, CO
National Provider Identifier
1336431998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY.0005018
- Practice address
- 2935 Baseline Rd Ste 303
Boulder, CO 80303-2367 - Phone
- (303) 200-0795
- NPI assigned
- May 13, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30744 | TX | |
| Clinical Psychologist | 103TC0700X | PSY.0005018 | CO | Primary |
Addresses
Primary practice location
2935 Baseline Rd Ste 303
Boulder, CO 80303-2367
Mailing address
2935 Baseline Rd Ste 303
Boulder, CO 80303-2367
Phone (303) 200-0795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 27, 2023 through Apr 27, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0005018 | CO | MD | Clinical Psychologist |
| 30744 | TX | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568937600000",
"number": "1336431998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2935 BASELINE RD STE 303",
"city": "BOULDER",
"state": "CO",
"postal_code": "803032367",
"telephone_number": "303-200-0795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2935 BASELINE RD STE 303",
"city": "BOULDER",
"state": "CO",
"postal_code": "803032367",
"telephone_number": "303-200-0795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "LYNDA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-13",
"last_updated": "2019-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "30744",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "PSY.0005018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.