| NPI | 1689214959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRA JEAN RUSSELL FOX Clinical Mental Health Counselor 505-220-5809 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2020-01-14 |