| NPI | 1356104525 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN CARLOS ETIENNE Sole Proprietor 915-346-5048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-31 |
| Last Update Date | 2025-09-22 |