| NPI | 1023221504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY O HORTON Owner 208-782-0376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID PSY-164) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |