| NPI | 1043054075 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RADLEY PETERSON Owner 208-899-5997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-10-27 |