| NPI | 1104578319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIRIAM WHITTAM Practice Manager 505-358-0087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2022-01-19 |