| NPI | 1063783728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULA MICHELLE NORDSTROM Owner 208-989-1686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ID PSY-303) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2019-07-29 |