Healthcare Provider Details

I. General information

NPI: 1760275598
Provider Name (Legal Business Name): MTX CARE COLORADO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N MILL ST STE 210
ASPEN CO
81611-1546
US

IV. Provider business mailing address

225 N MILL ST STE 210
ASPEN CO
81611-1546
US

V. Phone/Fax

Practice location:
  • Phone: 970-315-2324
  • Fax:
Mailing address:
  • Phone: 970-315-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAWRENCE WALL
Title or Position: DIRECTOR
Credential:
Phone: 970-404-5872