| NPI | 1306302898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA RAYVONTI Administration 208-353-8887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2019-02-20 |