| NPI | 1548145162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JORDAN POND Managing Partner 208-516-0248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-10-14 |