| NPI | 1568109742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JON MENDENHALL Owner/Business Administrator 208-557-9450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |