Provider Demographics
NPI:1649830316
Name:LIFTAFFECT LLC
Entity type:Organization
Organization Name:LIFTAFFECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-808-4617
Mailing Address - Street 1:4155 E JEWELL AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4507
Mailing Address - Country:US
Mailing Address - Phone:303-808-4617
Mailing Address - Fax:303-593-5429
Practice Address - Street 1:4155 E JEWELL AVE STE 308
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4507
Practice Address - Country:US
Practice Address - Phone:303-808-4617
Practice Address - Fax:303-593-5429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-16
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health