| NPI | 1487318960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERI PETERSON Credentialing Specialist 208-954-5594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2021-10-29 |