| NPI | 1659063600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS AARON RUSSELL Cco (Chief Counseling Officer) 575-495-4526 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2023-08-16 |