Mountain Lake Associates,pc

NPI 1154386555 - Counselor - 101YA0400X

NPI Details
NPI 1154386555
Enumeration Date 04/19/2006
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name BEVERLY A BEVERLY
Position PRESIDENT
Phone (719) 686-8560
Fax (719) 227-7745
Practice Location
724 N TEJON ST
COLORADO SPRINGS CO, 80903-1012, US
Phone (719) 686-8560
Fax (719) 227-7745
Business Location
333 W. LAKE ST
SUITE 2E
WOODLAND PARK CO, 80863, US
Phone (719) 686-8560
Fax (719) 227-7745
Toxanomy
Taxonomy Code 101YA0400X
License State Colorado
License Number 242
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According to our database, Mountain Lake Associates,pc NPI is 1154386555, taxonomy code is 101YA0400X and license number is 242, license state is located at Colorado. Mountain Lake Associates,pc physically located at 724 N Tejon St, Colorado Springs CO, 80903-1012. NPI Number 1033115704 has the healthcare provider type.

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1154386555 NPI number is provided on an as is basis without warranty of any kind. 1154386555 is maintained by the National Plan & Provider Enumeration System. The contents of Mountain Lake Associates,pc are for informational purposes only.