| NPI | 1285086769 |
|---|---|
| Doing Business As | DBA MESA VISTA WELLNESS |
| Entity Type | Organization |
| Authorized Contact | TOD DICECCO Executive Director 505-983-8225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 1600129265) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2016-07-07 |