| NPI | 1417945254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CHAVEZ Contract & Credentialing Manager 719-383-5448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: CO 0426) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2022-09-13 |