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 |