=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598152340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE INVISION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2015
-----------------------------------------------------
Last Update Date | 04/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8671 WOLFF CT 220
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80031-3609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-822-4242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 471
-----------------------------------------------------
City | NIWOT
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80544-0471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-822-4242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR THERAPIST
-----------------------------------------------------
Name | KATHERINE R MANN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 720-484-1247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 5338
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------