| NPI | 1598218190 |
|---|---|
| Other Name | JEN WILLIS LISW |
| Entity Type | Organization |
| Authorized Contact | JENNIFER BETH WILLIS Sole Proprietor 505-639-1312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM I-06999) |
| Additional Taxonomies | 251S00000X (Licence: NM C-06999) |
| 101YM0800X Counselor, Mental Health (Licence: NM I-06999) | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2018-11-27 |