| NPI | 1578776738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM MYLET Director 505-751-1223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0077511) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-08-22 |