| NPI | 1932473741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE R BRODERSON Nurse Practitioner 505-428-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM MB2485490) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2013-07-31 |