Provider Demographics
NPI:1760275598
Name:MTX CARE COLORADO, PLLC
Entity type:Organization
Organization Name:MTX CARE COLORADO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-404-5872
Mailing Address - Street 1:225 N MILL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1546
Mailing Address - Country:US
Mailing Address - Phone:970-315-2324
Mailing Address - Fax:
Practice Address - Street 1:225 N MILL ST STE 210
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1546
Practice Address - Country:US
Practice Address - Phone:970-315-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MTX CARE COLORADO, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder