Nicholas Jacob Matalik

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

647 Philadelphia St Ste 303
Indiana, PA 15701-3923

Phone

(724) 599-4060

NPI assigned

Jan 21, 2021

Reactivated

Feb 26, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mindful Roots Counseling, LLC

  • Mental Health Counselor
  • Indiana, PA
  • NPI 1558952184
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1649860909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 ELM ST",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013131",
            "telephone_number": "724-599-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 PHILADELPHIA ST STE 303",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013923",
            "telephone_number": "724-599-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATALIK",
        "first_name": "NICHOLAS",
        "middle_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "deactivation_date": "2021-01-27",
        "reactivation_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawna M. Marshall, PA-C
• Holly M Marusa, M ED.
• Kathleen M Marusa, LCSW
• Eric Massof
• Alyssa Matalik
• Allison Laurel Matava, CRNP
• Nicole Lee Ann Matko, BA
• Maximum Chiropractic
• Ralph M. May, PSY.D.
• Ellen McAninch, B.A.

• Professional Counselor in Indiana, PA
• Providers in Indiana, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.