Provider Demographics
NPI:1336550235
Name:LIVING WELL TRANSITIONS
Entity Type:Organization
Organization Name:LIVING WELL TRANSITIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BACCELLIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:303-245-1020
Mailing Address - Street 1:1320 PEARL ST STE 320
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5370
Mailing Address - Country:US
Mailing Address - Phone:303-245-1020
Mailing Address - Fax:303-245-1001
Practice Address - Street 1:1320 PEARL ST STE 320
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5370
Practice Address - Country:US
Practice Address - Phone:303-245-1020
Practice Address - Fax:303-245-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONONE REQUIRED251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health