| NPI | 1184496515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J DECKER Partner 208-403-4140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-30 |