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 |