| NPI | 1245312719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN SANCHEZ Medicaid Services Technician 505-257-2368 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 257884) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-08-22 |