Provider Demographics
NPI:1871144774
Name:BYNUM, MATTHEW (MA, LPCC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BYNUM
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6680 GUNPARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3349
Mailing Address - Country:US
Mailing Address - Phone:720-387-8458
Mailing Address - Fax:720-306-5190
Practice Address - Street 1:6680 GUNPARK DR STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3349
Practice Address - Country:US
Practice Address - Phone:720-387-8458
Practice Address - Fax:720-306-5190
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPCC17009Medicaid