| NPI | 1588006217 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE GORDON Owner 208-356-5675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCSW 27205) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2013-07-23 |