Healthcare Provider Details

I. General information

NPI: 1235040536
Provider Name (Legal Business Name): BENJAMIN C MELHORN LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 BIG TIMBER DR UNIT 3
CONIFER CO
80433-6410
US

IV. Provider business mailing address

PO BOX 102
CONIFER CO
80433-0102
US

V. Phone/Fax

Practice location:
  • Phone: 720-722-3961
  • Fax: 720-759-3523
Mailing address:
  • Phone: 720-722-3961
  • Fax: 720-759-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009927932
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: