| NPI | 1053860585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA FROCK Owner, Clinical Counselor 505-507-9087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: NM 1314) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2016-09-26 |