| NPI | 1154976637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNONELAINE S JOHN Mental Health Provider / Owner 720-443-0406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2021-01-15 |