| NPI | 1619344637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL THURSTON Owner 208-215-1568 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101258812) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2022-12-29 |