| NPI | 1063888766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERI WAGNER Owner And Provider 719-469-0716 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4842) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |