Healthcare Provider Details

I. General information

NPI: 1699594135
Provider Name (Legal Business Name): LIFELINE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 S BROADWAY
ENGLEWOOD CO
80113-4694
US

IV. Provider business mailing address

4 SUNSET LN
GREENWOOD VILLAGE CO
80121-1250
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-4696
  • Fax:
Mailing address:
  • Phone: 720-507-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MONICA MCINTYRE
Title or Position: FOUNDER
Credential: LAC, LPC
Phone: 720-507-4696