| NPI | 1194331215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE A NICOLL Clinical Psychologist 719-232-5223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |