| NPI | 1487273637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA JACKSON Owner 208-552-0855 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-04-08 |