| NPI | 1164506440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN SANCHEZ Medicaid Technician 505-257-2368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: NM 025861) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-08-22 |