Provider Demographics
NPI:1992392997
Name:NEST LIFE COLORADO, LLC
Entity Type:Organization
Organization Name:NEST LIFE COLORADO, LLC
Other - Org Name:LIFETRIBE COLORADO, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-201-2223
Mailing Address - Street 1:360 CENTRAL AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3984
Mailing Address - Country:US
Mailing Address - Phone:727-201-2389
Mailing Address - Fax:855-224-4326
Practice Address - Street 1:200 UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1831
Practice Address - Country:US
Practice Address - Phone:727-201-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty