| NPI | 1124372370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHALI BERLIN Owner 208-678-3555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2020-11-11 |