| NPI | 1538149497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM GLENN BORDELON Owner/Officer 970-245-3212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1428) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 649) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2020-08-22 |