| NPI | 1275262727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMI OWEN Owner 208-740-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-03-05 |