| NPI | 1295392868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGDALENE LIM Director 719-255-8002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |