| NPI | 1639595291 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA B. HAGSTRUM Owner 505-660-0403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-08107) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2014-03-06 |