| NPI | 1144059296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENEANE LAZO Owner 970-310-7706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-09-26 |