| NPI | 1083366777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER JOHNSON Clinical Director 208-660-9332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-01-24 |
| Last Update Date | 2022-01-24 |