| NPI | 1639868474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CHILCOTT Owner 208-304-2906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2024-03-13 |