| NPI | 1154919694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI D CODDINGTON Registered Agent 505-333-7219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-01-08 |