| NPI | 1255820205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY SUSAN MCKENNA Owner 505-274-0112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 0139371) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2023-11-13 |