| NPI | 1548316128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MARIE JACOBSEN Counselor 719-520-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 4035) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 177) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-08-22 |