| NPI | 1194555771 |
|---|---|
| Doing Business As | EASTERN LIGHT PSYCHIATRY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL SCOTT Practice Owner 208-313-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |