| NPI | 1043921869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN DEAN NUTT President 575-935-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2025-02-06 |