| NPI | 1043607732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY LEWIS Director 505-933-4639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0109871) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2015-04-20 |