| NPI | 1003458357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MADELEINE WILSON President 505-903-0927 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2024-10-07 |