| NPI | 1558984005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WALLACE Owner 970-368-9185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2020-06-13 |