Provider Demographics
NPI:1609286863
Name:LIFECRAFTING
Entity Type:Organization
Organization Name:LIFECRAFTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:INGA
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-459-4776
Mailing Address - Street 1:2807 HARLAN ST
Mailing Address - Street 2:107
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-8324
Mailing Address - Country:US
Mailing Address - Phone:303-459-4776
Mailing Address - Fax:888-364-3832
Practice Address - Street 1:3035 W 25TH AVE
Practice Address - Street 2:703
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4635
Practice Address - Country:US
Practice Address - Phone:303-459-4776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty