| NPI | 1538603667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORIE SUE COOK Clinical Administrator 208-461-3720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCSW-29576) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |