Organization Name: | SPRINGBOK HEALTH INC |
NPI Number: | 1134500903 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK JANKELOW (OWNER) |
Mailing Address: | 63 E Spaulding Ave E114 Pueblo West |
State: | CO US |
Postal Code: | 810075416 |
Phone Number: | 7192516877 |
Fax Number: | |
NPI Enumeration Date: | 06/17/2015 |
NPI Last Update Date: | 06/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | APN.0990467-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |