| NPI | 1598413338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE WALL Managing Director 970-404-5872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2024-01-07 |