| NPI | 1447776695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREL M SHAFTER Owner/Operator 505-577-7866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 17-00146320) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2019-09-10 |