Healthcare Provider Details

I. General information

NPI: 1255898169
Provider Name (Legal Business Name): JAMEIKA MATLOCK MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 FIREFLY CIR
COLORADO SPRINGS CO
80916-3940
US

IV. Provider business mailing address

1253 FIREFLY CIR
COLORADO SPRINGS CO
80916-3940
US

V. Phone/Fax

Practice location:
  • Phone: 719-321-0727
  • Fax:
Mailing address:
  • Phone: 719-321-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00188931
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: