| NPI | 1669859500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE HARPER Billing And Credentialing Specialis 505-414-7721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM LPCC #0172491) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2015-04-29 |