| NPI | 1235693284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LZICAR Owner 208-614-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |