Healthcare Provider Details

I. General information

NPI: 1891132239
Provider Name (Legal Business Name): MATTHEW MLYNARCZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 EAST MAIN AVE. #4
MANCOS CO
81328
US

IV. Provider business mailing address

114 EAST MAIN AVE. #4
MANCOS CO
81328
US

V. Phone/Fax

Practice location:
  • Phone: 303-853-3500
  • Fax: 970-074-9767
Mailing address:
  • Phone: 303-853-3500
  • Fax: 970-074-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001717
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: