| NPI | 1497620116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LOUISE RUSSELL Owner 208-610-6459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-10-10 |
| Last Update Date | 2025-10-10 |