| NPI | 1225507668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA HATCH Business Manager 208-346-1858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2021-11-15 |