| NPI | 1063837003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARRY ROBB REDFORD Owner 208-604-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID LMSW - 26140) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2014-11-10 |