| NPI | 1225043904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN E JACKSON Credentialing Coordinator 575-488-2500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 3040B1) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2022-07-07 |