| NPI | 1215399464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARI CHRISTINA NELSON Owner/Clinician 208-421-4293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-6017) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2016-03-27 |