MEDICARE: CARLY IRENE MATTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1104751064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLY IRENE MATTICE

Provider Business Mailing Address
First Line	:	4343 WOMACK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-2721
Country	:	US
Telephone Number	:	719-418-1154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 101
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	718-423-7428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ CARLY IRENE MATTICE ” Practice Location

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