| NPI | 1306726674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GALLUP Clinical Psychologist 208-406-2492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2025-09-05 |
| Last Update Date | 2025-09-05 |