| NPI | 1114139565 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LEE ANDES Co Manager 505-438-9592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM LPC0915) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2020-08-22 |