Organization
LIFETIME WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE B BYINGTON LCSW (PRESIDENT)
(303) 589-6802
Entity
Organization
Contact information
Practice address
1675 UPLAND AVE, BOULDER, CO 80304-0830
(303) 589-6802
Mailing address
PO BOX 876, NIWOT, CO 80544-0876
(303) 589-0680
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
992045
CO
Other
Enumeration date
08/05/2007
Last updated
08/05/2007
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