| NPI | 1376933168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIA LISA OTT Clinical Psychologist 719-465-4340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 3064) |
| Enumeration Date | 2015-01-31 |
| Last Update Date | 2015-02-23 |