| NPI | 1730513912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRUDENCIO A COSYLEON Provider 719-214-0626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 991432) |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2013-08-24 |