NPI | 1629104047 |
---|---|
Entity Type | Organization |
Authorized Contact | MELISSA M BEAN Program Manager 208-528-5706 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
Enumeration Date | 2007-02-27 |
Last Update Date | 2020-08-22 |