| NPI | 1578156626 |
|---|---|
| Doing Business As | KETAMINE COLORADO SPRINGS |
| Entity Type | Organization |
| Authorized Contact | JANA GAINOK Co Owner / Member 760-780-8702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-18 |