| NPI | 1184766396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH AL LIPETZKY Manager 208-373-0790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2018-12-12 |