| NPI | 1003101577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE ELAINE SULLIVAN Owner/Therapist 208-523-1558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2011-11-30 |