| NPI | 1275986457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA MOORE Owner 505-333-4173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 0140691) |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2016-07-22 |