Active NPI
Matthew Ponak, MA
- Mental Health Counselor
- Boulder, CO
National Provider Identifier
1558759399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- NLC.0105066
- Practice address
- 1200 Yarmouth Ave Unit C-1B
Boulder, CO 80304-4803 - Phone
- (303) 786-9314
- NPI assigned
- Jan 1, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NLC.0105066 | CO | Primary |
Addresses
Primary practice location
1200 Yarmouth Ave Unit C-1B
Boulder, CO 80304-4803
Mailing address
1200 Yarmouth Ave Unit C-1B
Boulder, CO 80304-4803
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NLC.0105066 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420070400000",
"number": "1558759399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 YARMOUTH AVE UNIT C-1B",
"city": "BOULDER",
"state": "CO",
"postal_code": "803044803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 YARMOUTH AVE UNIT C-1B",
"city": "BOULDER",
"state": "CO",
"postal_code": "803044803",
"telephone_number": "303-786-9314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONAK",
"first_name": "MATTHEW",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-01",
"last_updated": "2015-01-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "NLC.0105066",
"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 Jan 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.