=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235040536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN C MELHORN LSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2026
-----------------------------------------------------
Last Update Date | 09/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12424 BIG TIMBER DR UNIT 3
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-6410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-722-3961
-----------------------------------------------------
Fax | 720-759-3523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 102
-----------------------------------------------------
City | CONIFER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80433-0102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-722-3961
-----------------------------------------------------
Fax | 720-759-3523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LSW.0009927932
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------