| NPI | 1063859015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOURTNEY T VAILLANCOURT Owner 575-312-6085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0109041) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-01-19 |