| NPI | 1598276438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYDELL J BOOTH Psychologist/Owner 208-377-1131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID Psy-211) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |