Healthcare Provider Details

I. General information

NPI: 1043671936
Provider Name (Legal Business Name): LIFELONG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 10/04/2019
Certification Date:
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: 303-573-0849
Mailing address:
  • Phone: 303-573-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW2081
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberCSW2081
License Number StateCO

VIII. Authorized Official

Name: LINDSEY SPRAKER
Title or Position: OWNER
Credential:
Phone: 720-582-3086