| NPI | 1336912682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA PRATT Credentialing Specialist 505-207-8929 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-08-19 |