=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760854244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW DIRECTIONS FOR LIFE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2015
-----------------------------------------------------
Last Update Date | 10/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6635 S DAYTON ST #30
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-2241
-----------------------------------------------------
Fax | 303-379-5560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 270849
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80127-0015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-933-2241
-----------------------------------------------------
Fax | 303-379-5560
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/COUNSELOR
-----------------------------------------------------
Name | SHAWN DINKEL
-----------------------------------------------------
Credential | M.A., L.P.C., CACII
-----------------------------------------------------
Telephone | 303-933-2241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 20091072432
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------