| NPI | 1629800313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA SALAZAR Billing Manager 406-258-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2025-04-16 |