| NPI | 1669074902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY CHACON Owner 505-315-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2020-11-11 |