| NPI | 1346786902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE A MEDINA Practice Manager 505-470-2887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2020-04-03 |