| NPI | 1649262825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLA ANDERSEN Physician/Partner 208-524-4953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LCSW-1311) |
| 101Y00000X Counselor (Licence: ID LCPC-323) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ID M8621) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2008-11-03 |