| NPI | 1578758207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL BRENT LIESTER Chairman/Owner 719-488-0024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CO 29395) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2007-09-06 |