| NPI | 1487229688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BLACKWOOD Credentialing 208-737-6718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041S0200X Social Worker, School | |
| 101YM0800X Counselor, Mental Health | |
| 101YS0200X Counselor, School | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2021-05-21 |