Healthcare Provider Details

I. General information

NPI: 1528973252
Provider Name (Legal Business Name): PAYTON MATEJKO , BA, MASTERS INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S COLLEGE AVE UNIT 202
FORT COLLINS CO
80525-2558
US

IV. Provider business mailing address

1437 DENVER AVE # 325
LOVELAND CO
80538-5226
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-4057
  • Fax:
Mailing address:
  • Phone: 970-221-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: