| NPI | 1467268953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY BRIAN TENNY Owner 208-816-0015 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2024-12-09 |