| NPI | 1316833502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY A WYNN Chief Clinical Officer 505-670-7765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-06-16 |