| NPI | 1356164479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN HAVENS Owner 719-359-6035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2024-11-06 |