| NPI | 1518527258 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY MICHAEL BRADSHAW Psychologist / President 208-310-9884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2019-06-15 |