| NPI | 1518217983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANET RUTH LOVELAND Counselor 208-312-2510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: ID 3745) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: ID 3745) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2012-09-13 |