| NPI | 1568884013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZANE P NELSON Owner/ Provider 208-376-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: ID PSY84) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |