| NPI | 1396400651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA DERN Counselor 208-274-4025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2021-11-02 |