| NPI | 1053615260 |
|---|---|
| Doing Business As | STATE HOSPITAL SOUTH GROUP |
| Entity Type | Organization |
| Authorized Contact | LORNA B COLVIN Patient Account Specialist 208-785-8506 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID 17) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2011-01-03 |