| Living Your Dance | |
|
1320 Stonehaven Ave Broomfield CO 80020-2477 | |
| (303) 882-9065 | |
| Not Available |
| Full Name | Living Your Dance |
|---|---|
| Speciality | Counselor |
| Location | 1320 Stonehaven Ave, Broomfield, Colorado |
| Authorized Official Name and Position | Jennifer Lusk-puerner (OWNER) |
| Authorized Official Contact | 3038829065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Your Dance 1320 Stonehaven Ave Broomfield CO 80020-2477 Ph: (303) 882-9065 | Living Your Dance 1320 Stonehaven Ave Broomfield CO 80020-2477 Ph: (303) 882-9065 |
| NPI Number | 1336623305 |
|---|---|
| Provider Enumeration Date | 09/17/2018 |
| Last Update Date | 04/26/2024 |
| Certification Date | 04/26/2024 |
| Medicare PECOS PAC ID | 3779923735 |
|---|---|
| Medicare Enrollment ID | O20240424003930 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336623305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Jennifer L Lusk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104174069 PECOS PAC ID: 4688014640 Enrollment ID: I20240507000344 |
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