Healthcare Provider Details

I. General information

NPI: 1689273435
Provider Name (Legal Business Name): LIFELONG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 W JEFFERSON AVE STE 4000
LAKEWOOD CO
80235-2336
US

IV. Provider business mailing address

7175 W JEFFERSON AVE STE 4000
LAKEWOOD CO
80235-2336
US

V. Phone/Fax

Practice location:
  • Phone: 303-573-0839
  • Fax:
Mailing address:
  • Phone: 303-573-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY SPRAKER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 720-582-3086