| NPI | 1629315692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLA ANDERSEN Billing & Credentialing 208-529-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2020-09-10 |