| NPI | 1790262376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD C. GIBSON Owner 719-360-4369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-07-26 |