| NPI | 1326819616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA WILKERSON Licensed Clinical Social Worker 208-830-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2025-08-20 |