| Southern Colorado Youth Development | |
|
2828 Granada Blvd Pueblo CO 81005-3104 | |
| (719) 671-6188 | |
| Not Available |
| Full Name | Southern Colorado Youth Development |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2828 Granada Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Michael S Riley (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7196716188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Colorado Youth Development 2828 Granada Blvd Pueblo CO 81005-3104 Ph: (719) 671-6188 | Southern Colorado Youth Development 2828 Granada Blvd Pueblo CO 81005-3104 Ph: (719) 671-6188 |
| NPI Number | 1124784913 |
|---|---|
| Provider Enumeration Date | 11/16/2021 |
| Last Update Date | 11/16/2021 |
| Certification Date | 11/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124784913 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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