| NPI | 1528795093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA MCCREARY Office Manager 208-981-1992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2022-08-04 |