| NPI | 1336892686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BERENGER Lcpc 208-963-8132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-10-28 |