| NPI | 1366158461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL CLEMENS Owner 208-598-8442 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2023-03-10 |