Healthcare Provider Details

I. General information

NPI: 1841910544
Provider Name (Legal Business Name): MATTHEW CARL AARON PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 OPUS DR
COLORADO SPRINGS CO
80906-8694
US

IV. Provider business mailing address

4729 OPUS DR
COLORADO SPRINGS CO
80906-8694
US

V. Phone/Fax

Practice location:
  • Phone: 719-289-3173
  • Fax: 866-718-1677
Mailing address:
  • Phone:
  • Fax: 866-718-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1099669
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number756065
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: