| NPI | 1235401522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULI POPEJOY Billing Manager 208-525-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2015-02-24 |