| NPI | 1124642293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY CROFT Owner/Provider 208-938-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |