| NPI | 1275936882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN FULLMER Owner 208-521-4332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-09-27 |
| Last Update Date | 2014-09-27 |