| NPI | 1770901506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRI J BALLARD Clinical Mental Health Counselor 505-310-1876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM 0188661) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2017-04-18 |