| NPI | 1134629058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA K MALOTT Office Manager 575-973-0292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0190751) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |