Organization
ADULT YOUTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY GUPTON-JOHNSON MSW (OWNER/CEO)
(719) 442-1779
Entity
Organization
Contact information
Practice address
223 N WAHSATCH AVE, STE 101, COLORADO SPRINGS, CO 80903-3479
(719) 442-1779
(719) 442-0538
Mailing address
223 N WAHSATCH AVE, STE 101, COLORADO SPRINGS, CO 80903-3479
(719) 442-1779
(719) 442-0538
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
01/25/2016
Last updated
01/25/2016
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