| NPI | 1477049492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILLARY DAWN COOK Owner 208-391-2957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: ID LPC-6772) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: ID LPC-6772) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: ID LPC-6772) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |