| NPI | 1790970879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA S DAVISON CEO 505-717-1155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: NM PT0088431) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2023-12-27 |