| NPI | 1376277491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY JOHNSON Private Practice Owner 719-345-7095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251S00000X | |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-14 |