NPI | 1194366153 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN YUMA BRANNON Lead Clinician 719-999-5054 |
Organization Subpart ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional |
Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2019-10-01 |
Last Update Date | 2019-10-01 |