| NPI | 1831797562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY KLENE Owner 720-515-0194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2024-11-26 |