| NPI | 1912645458 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FRAILEY Hr 719-389-1108 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2022-05-24 |