Provider Demographics
NPI:1306520572
Name:PHILLIIPS, MATTHEW STEPHEN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:PHILLIIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BASSETT ST UNIT 1207
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1922
Mailing Address - Country:US
Mailing Address - Phone:720-202-8272
Mailing Address - Fax:
Practice Address - Street 1:1355 S COLORADO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3358
Practice Address - Country:US
Practice Address - Phone:303-756-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty