| NPI | 1336915495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL SCOTT Owner 208-313-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-11-30 |
| Last Update Date | 2024-02-25 |