| NPI | 1912316308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LYN TREVINO Provider/Operator 5754-644-9209 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0116921) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2014-08-11 |