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General NPI Number Information
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NPI Number | 1689045122
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Entity Type | Organization
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Legal Business Name | LIFECRAFT COUNSELING LLC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 2755 S LOCUST ST STE 115
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City | DENVER
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State | CO
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Zip | 80222-7126
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Country | US
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Telephone | 303-952-0168
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 CLAYTON ST
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City | DENVER
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State | CO
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Zip | 80206-3210
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Country | US
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Telephone | 303-952-0168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GIDEON KILLION
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Credential | MA, NCC
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Telephone | 720-340-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NLC.0104854
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | NLC.0104854
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License Number State | CO
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