| NPI | 1619562980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMMIE LYN JOHN Owner 208-206-2864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2026-09-09 |