| NPI | 1083152144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN M RUSSELL Owner/Director 208-687-0538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 36280) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2017-02-08 |