| NPI | 1043751175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONNA MAHANA Provider Relations 208-287-9420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-3442) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2017-03-08 |