| NPI | 1225877228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOU DURAN Credentialer 505-270-3966 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-05-21 |
| Last Update Date | 2024-05-21 |