| NPI | 1225890619 |
|---|---|
| Doing Business As | FOUNTAIN VALLEY BEHAVIORAL HEALTH |
| Entity Type | Organization |
| Authorized Contact | JACQUITA LOUISE JORDAN Owner 719-358-7338 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-02-09 |