| NPI | 1003301680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE R FITTING Supervisor 208-743-5906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-26273) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-06-26 |