| NPI | 1093013526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELE DAWN JOHNSON Sole Owner 970-214-5712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CO 992151) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-03-08 |