Provider Demographics
NPI:1649536665
Name:TREE OF LIFE PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:TREE OF LIFE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-261-4459
Mailing Address - Street 1:1705 S PEARL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3170
Mailing Address - Country:US
Mailing Address - Phone:720-261-4459
Mailing Address - Fax:
Practice Address - Street 1:1705 S PEARL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3170
Practice Address - Country:US
Practice Address - Phone:720-261-4459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991053261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health