| NPI | 1376670091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORA JO GUSSENHOVEN Program Manager 208-769-1406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |