| NPI | 1417366576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA MAE EICKHOLT Owner 406-777-6958 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MT MT37331) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MT MT37331) |
| Enumeration Date | 2014-08-03 |
| Last Update Date | 2014-08-03 |