| NPI | 1407360761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURISSA BUSTILLOS Therapist 575-649-4880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM T-0193001) |
| Enumeration Date | 2017-11-24 |
| Last Update Date | 2017-11-24 |