| NPI | 1245804400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BLACKWOOD Credentialing Specialist 208-737-6718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 122300000X Dentist | |
| 124Q00000X Dental Hygienist | |
| 133V00000X Dietitian, Registered | |
| 183500000X Pharmacist | |
| 207Q00000X Family Medicine | |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-26 |