Provider Demographics
NPI:1689421380
Name:MERCUR, MATHEW (MFTC)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:MERCUR
Suffix:
Gender:X
Credentials:MFTC
Other - Prefix:
Other - First Name:MATEO
Other - Middle Name:
Other - Last Name:MERCUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4555 13TH ST UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4823
Mailing Address - Country:US
Mailing Address - Phone:805-452-8385
Mailing Address - Fax:
Practice Address - Street 1:4555 13TH ST UNIT 2C
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4823
Practice Address - Country:US
Practice Address - Phone:805-452-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist