| NPI | 1518080944 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GERVASI Corp Dir Of Contract Mgmt 505-550-9182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0093481) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2020-08-22 |