NPI | 1164189155 |
---|---|
Entity Type | Organization |
Authorized Contact | CHERI PETERSON Credentialing Specialist 208-954-5594 |
Organization Subpart ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
Enumeration Date | 2021-11-24 |
Last Update Date | 2021-11-24 |