| NPI | 1598748337 |
|---|---|
| Former Legal Business Name | STATE OF IDAHO |
| Entity Type | Organization |
| Authorized Contact | KELLY S BOSTER Office Specialist Ii 208-455-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2024-02-02 |