| NPI | 1558742379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANA MEGAN DAVIS Owner/Provider 505-270-7599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0140881) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |