| NPI | 1316598063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE RASMUSSEN DANGREMOND Provider 719-900-3633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2022-09-12 |