| NPI | 1275932220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL STEWART LEE Owner 208-365-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |