| NPI | 1457898348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILL LAFRENIERE Credentialing Manager 575-532-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2020-01-15 |