| NPI | 1104048503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA BRIGHT Manager 208-405-0587 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2019-09-09 |