| NPI | 1639894785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVA LESLIE Mental Health Clinician 208-412-7196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2022-10-10 |