| NPI | 1053710004 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN SANCHEZ Medicaid Tech 575-937-2497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 299611) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |