| NPI | 1396028544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WALLACE Private Practitioner 970-817-4049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5913) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2015-12-16 |