| NPI | 1114599321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA BATTS Billing Manager 208-380-4978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2021-07-15 |