| NPI | 1336737238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON JOHNSON Owner 208-994-6458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2021-08-11 |