| NPI | 1083126023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROUTT President 208-454-1480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2023-08-11 |