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General NPI Number Information
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NPI Number | 1609286863
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Entity Type | Organization
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Legal Business Name | LIFECRAFTING
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 3035 W 25TH AVE 703
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City | DENVER
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State | CO
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Zip | 80211-4635
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Country | US
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Telephone | 303-459-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 HARLAN ST 107
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City | EDGEWATER
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State | CO
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Zip | 80214-8324
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Country | US
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Telephone | 303-459-4776
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Fax | 888-364-3832
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MS. INGA KAREN LARSON
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Credential | LCSW
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Telephone | 303-459-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1964
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License Number State | CO
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