| NPI | 1487910402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN PARKS Director 505-490-9049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM 1183) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1183) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2016-08-11 |