| NPI | 1639292626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED RYAN OSTERMILLER Owner Manager 208-359-9683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: ID LCSW-1351) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-03-16 |