| NPI | 1518451855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNE DIZENZO Member/Behavior Therapist 505-860-9592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: NM 1-07467) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CO 1769) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2018-06-20 |