| NPI | 1043074024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUITA LOUISE JORDAN Owner 719-358-7338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-02-09 |
| Last Update Date | 2024-02-09 |