NPI | 1225646391 |
---|---|
Entity Type | Organization |
Authorized Contact | LORIE FULLER Behavioral Health Provider/Sole Pr 970-901-0937 |
Organization Subpart ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional |
Enumeration Date | 2020-07-15 |
Last Update Date | 2021-12-28 |