Provider Demographics
NPI:1669838710
Name:LIFE UNTANGLED, LLC
Entity Type:Organization
Organization Name:LIFE UNTANGLED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SOUCIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:970-520-0738
Mailing Address - Street 1:330 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3177
Mailing Address - Country:US
Mailing Address - Phone:970-520-0738
Mailing Address - Fax:
Practice Address - Street 1:330 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3177
Practice Address - Country:US
Practice Address - Phone:970-520-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization