| NPI | 1578338778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANDICE PETERSON Provider/Owner 208-427-5891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2023-11-17 |