| NPI | 1902402134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RUDNIK Credentialing Manager 719-423-1341 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |