| NPI | 1447969506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES RYAN SHACKELFORD Psychiatrist 208-297-3698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2022-11-17 |