| NPI | 1194063750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW ANDERSEN Director 208-232-0021 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID 0314) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2016-04-25 |