| 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 |