| NPI | 1194179853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA DIANE PFENNING Owner 208-699-0679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-4662) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2016-04-19 |