| NPI | 1083724215 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA S GORIN Owner 208-535-8549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ID M-9459) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-08-22 |