| NPI | 1922068931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS R PETERSEN-KELLEY Business Manager 719-275-7650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 302F00000X Exclusive Provider Organization (Licence: CO 1063-00) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2022-06-07 |