| NPI | 1932373743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD RAY LOBAUGH Ownder 505-463-2072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM R45675) |
| Additional Taxonomies | 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: NM R45675) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2012-09-19 |