| NPI | 1174629976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT DE WALL Owner/Administrator 208-233-7832 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-06-27 |