| NPI | 1366827255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA LIGHT BENNETT Owner/Clinical Supervisor/Clinician 208-746-4097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LCPC-2714) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-5714) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |