| NPI | 1194837351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD B TYE Clinical Director President 208-672-8699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ID PSY316) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ PSY3208) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-08-15 |