| NPI | 1508034802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERI PETERSON Credentialer 208-954-5594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M7712) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2021-04-21 |