Healthcare Provider Details

I. General information

NPI: 1285538942
Provider Name (Legal Business Name): KEVIN MASTERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13182 W JEWELL CIR
LAKEWOOD CO
80228-4251
US

IV. Provider business mailing address

13182 W JEWELL CIR
LAKEWOOD CO
80228-4251
US

V. Phone/Fax

Practice location:
  • Phone: 315-256-5050
  • Fax:
Mailing address:
  • Phone: 315-256-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0003801
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: