| NPI | 1255636395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA K GRIEGO Medicaid Coordinator 505-426-2554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: NM 271289) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |