| NPI | 1033736699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | XANDER JOHN BURGESS Owner 719-439-6785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2025-04-16 |