| NPI | 1457831786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRA JEAN BURGESS-ELMER Owner 208-488-2557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-6287) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |