| NPI | 1114417029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALLE STEPHANIE SMITH Owner 208-715-0218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2018-05-16 |