| NPI | 1063760452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE LYNN ALLEN Owner 208-200-4392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |