| NPI | 1013277128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNDA SMITH Lpc 208-602-2293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: ID 4841) |
| Additional Taxonomies | 251S00000X (Licence: ID 4841) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: ID 4841) | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2012-07-27 |