| NPI | 1871969691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDALL WILLIAM DATSON Therapist 719-540-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: CO LPC.0012577) |
| Enumeration Date | 2015-08-16 |
| Last Update Date | 2015-08-16 |