| NPI | 1114979747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYELENE HALEY Fiscal Officer 505-623-1480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-08-30 |