| NPI | 1609590264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARA THORNBERG Owner/Provider 505-331-0887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2023-12-01 |