| NPI | 1972150415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DITZLER Lpc 970-623-9830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2020-07-17 |