Active NPI
Matthew Al Thelen, PSYD
- Clinical Psychologist
- Colorado Springs, CO
National Provider Identifier
1942766720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0004060
- Practice address
- 602 E Uintah St
Colorado Springs, CO 80903-2539 - Phone
- (719) 651-3775
- NPI assigned
- Feb 15, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0004060 | CO | Primary |
Addresses
Primary practice location
602 E Uintah St
Colorado Springs, CO 80903-2539
Mailing address
602 E Uintah St
Colorado Springs, CO 80903-2539
Phone (719) 651-3775
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0004060 | CO | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550188800000",
"number": "1942766720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 E UINTAH ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809032539",
"telephone_number": "719-651-3775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 E UINTAH ST",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809032539",
"telephone_number": "719-651-3775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THELEN",
"first_name": "MATTHEW",
"middle_name": "AL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-15",
"last_updated": "2019-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "0004060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.