| NPI | 1225267149 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NELA J HOLLIS Owner 208-452-7190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID psy202138) |
| Additional Taxonomies | 251C00000X (Licence: ID psy202138) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2011-01-24 |