Individual provider Active NPI

Lily Amelia Mathison, PHD

  • Psychologist
  • Fort Collins, CO
National Provider Identifier
1689270886
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY.6287 Issued in CO
Practice address
215 W Oak St FL 4
Fort Collins, CO 80521-2734
Phone
(323) 590-1465
NPI assigned
Dec 11, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY.6287 CO Primary

Addresses

Primary practice location

215 W Oak St FL 4
Fort Collins, CO 80521-2734

Mailing address

215 W Oak St FL 4
Fort Collins, CO 80521-2734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, CO, TX3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20211122002617 IA Practitioner - Clinical Psychologist 1951790484
I20240130000741 CO Practitioner - Clinical Psychologist 1951790484
I20250221002191 TX Practitioner - Clinical Psychologist 1951790484 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

516 E Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1000

Hospital & facility affiliations

  • Gallup Indian Medical Center Hospital, Gallup, NM, CCN 320061

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY.6287COMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS, PHS, Naihs, Gallup Indian Medical Center CurrentSince Jan 27, 2025 Accepting new patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Jan 27, 2025 Accepting new patients
Integrative Counseling Solutions Inc. PastSince Nov 1, 2022 Accepting new patients

Locations

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704844800000",
    "number": "1689270886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W OAK ST FL 4",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805212734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W OAK ST FL 4",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805212734",
            "telephone_number": "323-590-1465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHISON",
        "first_name": "LILY",
        "middle_name": "AMELIA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "PSY.6287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

Verify at the official NPI Registry.