| NPI | 1639476294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI MALONE Program Manager 208-799-4440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2011-02-17 |
| Last Update Date | 2011-02-17 |