| NPI | 1619685138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEARA ANNE DUPONT ANCTIL Owner 208-228-3880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2022-12-20 |