Healthcare Provider Details

I. General information

NPI: 1104639038
Provider Name (Legal Business Name): MATHILE L SMITH MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MATHILE L HORNBACK

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8190 E 1ST AVE
DENVER CO
80230-7211
US

IV. Provider business mailing address

8190 E 1ST AVE
DENVER CO
80230-7211
US

V. Phone/Fax

Practice location:
  • Phone: 303-923-9014
  • Fax:
Mailing address:
  • Phone: 303-731-8199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0020585
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0020585
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: