Healthcare Provider Details

I. General information

NPI: 1538655162
Provider Name (Legal Business Name): MATT MCNEIL AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 E JEWELL AVE STE 308
DENVER CO
80222-4507
US

IV. Provider business mailing address

9532 PINEBROOK ST
HIGHLANDS RANCH CO
80130-3777
US

V. Phone/Fax

Practice location:
  • Phone: 303-808-4617
  • Fax:
Mailing address:
  • Phone: 303-808-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLPC.0013375
License Number StateCO

VIII. Authorized Official

Name: MR. MATTHEW COLLINS MCNEIL
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 303-808-4617