| NPI | 1508388513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER DANLEE MOORE Owner, Provider 208-917-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID 6408) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2018-03-17 |