| NPI | 1063286912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LAUREN MAMULA Owner 719-900-2481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2024-05-08 |