| NPI | 1861026809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentiaing 719-632-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 101Y00000X Counselor |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2020-10-26 |