MEDICARE: MADRID MITTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0021264	CO

General Provider Information

NPI Number	:	1396689147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADRID MITTON

Provider Business Mailing Address
First Line	:	2627 REDWING RD STE 220
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6331
Country	:	US
Telephone Number	:	970-239-1377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 REDWING RD STE 220
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6331
Country	:	US
Telephone Number	:	970-239-1377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ MADRID MITTON ” Practice Location

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