| NPI | 1194555771 |
|---|---|
| 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 | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |