| NPI | 1295060614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD M WAHL Sole Member 970-581-9398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WY 444) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 3094) |
| Enumeration Date | 2009-10-03 |
| Last Update Date | 2009-10-05 |