| NPI | 1437474624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN MACK Therapist / Owner 505-385-3963 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 4272969) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2013-04-03 |