| NPI | 1629718762 |
|---|---|
| Former Legal Business Name | MATTIE CLOS |
| Doing Business As | GENDER EXPANSIVE TELETHERAPY, LLC |
| Entity Type | Organization |
| Authorized Contact | RIKKI OLI CLOS Owner 720-580-0393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-09-23 |