| NPI | 1093302507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CRAWFORD Owner 208-899-9589 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2020-12-30 |