| NPI | 1629631817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA SALAZAR TAPIA Lcsw 208-421-1788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-02-06 |