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General NPI Number Information
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NPI Number | 1649830316
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Entity Type | Organization
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Legal Business Name | LIFTAFFECT LLC
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Dates
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Enumeration Date | 06/16/2019
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Last Update Date | 06/16/2019
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Provider Practice Location Address
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Address Line | 4155 E JEWELL AVE STE 308
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City | DENVER
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State | CO
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Zip | 80222-4507
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Country | US
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Telephone | 303-808-4617
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Fax | 303-593-5429
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Provider Business Mailing Address
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Address Line | 4155 E JEWELL AVE STE 308
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City | DENVER
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State | CO
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Zip | 80222-4507
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Country | US
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Telephone | 303-808-4617
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Fax | 303-593-5429
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. MATTHEW COLLINS MCNEIL
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Credential | LPC
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Telephone | 303-808-4617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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