| NPI | 1568765519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LANGE Director 208-265-8195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2012-05-01 |