Healthcare Provider Details

I. General information

NPI: 1194655357
Provider Name (Legal Business Name): GREGORY K. MATTHEWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 E LANSING CIR
ENGLEWOOD CO
80112-5909
US

IV. Provider business mailing address

11045 E LANSING CIR
ENGLEWOOD CO
80112-5909
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-4368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0023390
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: