| NPI | 1336333152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON ETNYRE Licensed Clinical Psychologist 208-906-2007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY-202238) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY-323) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-11-15 |