| NPI | 1124445762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELIE MARIE LARA Youth Counselor 915-731-5160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AK 10Y00000X) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |