| NPI | 1356649909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACEY JILL MACKENZIE Mental Health Counselor 208-739-0982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: ID LPC-4348) |
| Enumeration Date | 2011-03-07 |
| Last Update Date | 2011-03-07 |