| NPI | 1174909964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAGE S MASTOR Clinical Psychologist 575-737-9352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 0858) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |