| NPI | 1710125067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLENE A BRUTON Administrative Assistant 575-694-5748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2022-08-29 |