| NPI | 1902322456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANNA KIPNESS Owner 505-820-7562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NM 3188) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2017-08-16 |