| NPI | 1912275124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN HALFACRE Credentialing Specialist 505-352-5269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 1095) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2011-12-02 |