| NPI | 1104599331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA BRADLEY Licensed Professional Counselor 208-274-3020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-07-24 |
| Last Update Date | 2022-10-14 |