| NPI | 1376251835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA K NELSON Office Manager/Biller 208-514-5288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2024-02-05 |