| NPI | 1245745181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUTUMN ASCANO Owner 719-219-8626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |