| NPI | 1528136793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE JOHANSEN Administrator 208-732-0995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID LCPC3404) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M5371) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID LMFT-2687) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID LPC3381) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID PA499) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID LCPC3433) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID CNS12) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-08-22 |