| NPI | 1154127470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN LEIGH REVTYAK Executive Director 915-525-9482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2025-02-19 |
| Last Update Date | 2025-08-26 |