| NPI | 1255028221 |
|---|---|
| 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 | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 175T00000X Peer Specialist | |
| 207Q00000X Family Medicine | |
| 251B00000X Case Management | |
| 251S00000X | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-06-26 |