1467848465 NPI number — INTENTIONAL LIVING COUNSELING

Table of content: (NPI 1467848465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467848465 NPI number — INTENTIONAL LIVING COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENTIONAL LIVING COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467848465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 LYNWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80126-8044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-521-0147
Provider Business Mailing Address Fax Number:
888-598-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7851 S ELATI ST STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80120-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-521-0147
Provider Business Practice Location Address Fax Number:
888-598-3113
Provider Enumeration Date:
04/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BURNS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-521-0147

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  290 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982745352 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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