| NPI | 1144685876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA RYAN Lcsw 208-982-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: ID LCSW-34461) |
| Additional Taxonomies | 251S00000X (Licence: NY 081479-1) |
| 251S00000X (Licence: TX 60450) | |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2015-12-22 |