Healthcare Provider Details

I. General information

NPI: 1649184854
Provider Name (Legal Business Name): WILLIAM FREDERIC MINTZER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KENDALL DR
LAMAR CO
81052-3939
US

IV. Provider business mailing address

525 S DAWSON ST UNIT 374
AURORA CO
80012-3953
US

V. Phone/Fax

Practice location:
  • Phone: 719-336-0261
  • Fax:
Mailing address:
  • Phone: 303-598-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0024852
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: