| NPI | 1033588207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA CARR PETERSON Owner 208-758-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2016-08-16 |