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General NPI Number Information
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NPI Number | 1609233410
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Entity Type | Organization
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Legal Business Name | ADULT YOUTH SERVICES
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 223 N WAHSATCH AVE STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3479
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Country | US
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Telephone | 719-442-1779
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Fax | 719-442-0538
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Provider Business Mailing Address
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Address Line | 223 N WAHSATCH AVE STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3479
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Country | US
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Telephone | 719-442-1779
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Fax | 719-442-0538
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MARY GUPTON-JOHNSON
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Credential | MSW
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Telephone | 719-442-1779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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