Healthcare Provider Details

I. General information

NPI: 1124504808
Provider Name (Legal Business Name): BE FREE LIVE NOW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 CENTER CREEN COURT SUITE G211
BOULDER CO
80301
US

IV. Provider business mailing address

1020 E 10TH AVE APT 309
BROOMFIELD CO
80020-1419
US

V. Phone/Fax

Practice location:
  • Phone: 720-352-9017
  • Fax:
Mailing address:
  • Phone: 720-352-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KIMBERLY HUGES
Title or Position: OWNER
Credential: LCSW
Phone: 720-352-9017