| NPI | 1104675826 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA THORNBERRY Bod Secretary 719-569-4712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP1600X Counselor, Pastoral | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2025-08-08 |