| NPI | 1598012700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL SMITH Billing 208-524-7400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: ID LPC2922) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |