| NPI | 1134592256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN PONDER Owner 970-590-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: CO 130627) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2023-08-02 |