Healthcare Provider Details

I. General information

NPI: 1649916081
Provider Name (Legal Business Name): MADISON PHILLIPS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10190 E MONTVIEW BLVD
AURORA CO
80010-2202
US

IV. Provider business mailing address

10190 E MONTVIEW BLVD
AURORA CO
80010-2202
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-4242
  • Fax:
Mailing address:
  • Phone: 303-318-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB729196
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009927824
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: