Provider Demographics
NPI:1104639038
Name:SMITH, MATHILE L (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:MATHILE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MATHILE
Other - Middle Name:L
Other - Last Name:HORNBACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8190 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7211
Mailing Address - Country:US
Mailing Address - Phone:303-731-8199
Mailing Address - Fax:
Practice Address - Street 1:8190 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7211
Practice Address - Country:US
Practice Address - Phone:303-923-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0020585101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health