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Limon, Colorado

Provider NPI: 1023011525

Provider Information:
Gender: M

Practice Location:
820 1ST ST.  LIMON, CO 80828 US
Tel: 719-775-2367  Fax: 719-775-2365

Business Mailing Address:
820 1ST ST.  LIMON, CO 80828 US
Tel: 719-775-2367  Fax: 719-775-2365

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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