Provider Demographics
NPI:1992328454
Name:LIFELINE TO FREEDOM, LLC
Entity type:Organization
Organization Name:LIFELINE TO FREEDOM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:719-497-9219
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:IDALIA
Mailing Address - State:CO
Mailing Address - Zip Code:80735-0032
Mailing Address - Country:US
Mailing Address - Phone:719-497-9219
Mailing Address - Fax:719-960-2813
Practice Address - Street 1:1371 ROSE AVE SIDE ENTRANCE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1601
Practice Address - Country:US
Practice Address - Phone:719-497-9219
Practice Address - Fax:719-960-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty