| NPI | 1104464460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MCDERMOTT Credentialing Specialist 505-712-2662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2025-05-20 |