| NPI | 1013628015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC LANGE Co Executive Director 719-471-0642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2022-12-09 |