| NPI | 1598077562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERIC V RAVSTEN Owner 208-233-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2013-11-23 |