| NPI | 1598515009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAISLEY ROSE CUMMINGS Owner/Clinical Director 208-417-2218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2024-10-26 |