| NPI | 1124590302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNEY ROCKHILL Counselor 208-419-6102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2024-01-16 |