| NPI | 1659026433 |
|---|---|
| Doing Business As | LIBERATEABQ |
| Entity Type | Organization |
| Authorized Contact | SCOTT THOMAS CLARK Owner 505-596-0614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2022-02-19 |
| Last Update Date | 2023-09-06 |