| NPI | 1770762775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILLIAM RAYBOULD President/Sole Owner Provider 505-573-4044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2024-02-10 |