| NPI | 1174673305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLA DINGMAN Adminstrator 208-478-8340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2013-01-16 |