| NPI | 1437401684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BRIDGES Counselor 208-523-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2012-10-12 |