| NPI | 1255412714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHYLLIS MONTGOMERY Lcsw 208-463-0212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: ID LCSW 712) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-08-22 |