Provider Demographics
NPI:1689045122
Name:LIFECRAFT COUNSELING LLC
Entity Type:Organization
Organization Name:LIFECRAFT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLION
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:720-340-1050
Mailing Address - Street 1:1050 CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3210
Mailing Address - Country:US
Mailing Address - Phone:303-952-0168
Mailing Address - Fax:
Practice Address - Street 1:2755 S LOCUST ST
Practice Address - Street 2:STE 115
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7126
Practice Address - Country:US
Practice Address - Phone:303-952-0168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104854101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty