| NPI | 1558763490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS A DEAN Owner 208-680-6488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-27235) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-10-27 |