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General NPI Number Information
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NPI Number | 1235958778
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Entity Type | Organization
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Legal Business Name | LIFELINE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 4045 S BROADWAY STE 107
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City | ENGLEWOOD
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State | CO
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Zip | 80113-4694
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Country | US
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Telephone | 720-507-4696
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SUNSET LN
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80121-1250
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Country | US
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Telephone | 720-507-4696
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MONICA MCINTYRE
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Credential | LPC, LAC
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Telephone | 720-507-4696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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