| NPI | 1770363004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN JOEL GAINEY Provider / Owner / CEO 719-208-4027 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2024-02-28 |