Healthcare Provider Details

I. General information

NPI: 1700677366
Provider Name (Legal Business Name): LIFEWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COUNTY ROAD 142
DURANGO CO
81303-3628
US

IV. Provider business mailing address

PO BOX 2866
DURANGO CO
81302-2866
US

V. Phone/Fax

Practice location:
  • Phone: 970-422-2304
  • Fax:
Mailing address:
  • Phone: 970-422-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
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: CHRISTOPHER BROWN
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 970-422-2304