| NPI | 1144238247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY WADE Clinical Director 208-745-0150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-120) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |