| NPI | 1932503166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN EDUARD WELLS Director 505-328-3764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM T-0619341) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2014-10-17 |