| NPI | 1649536053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRE MOORE Mental Health Clinician 208-375-0752 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LMSW-31866) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2012-04-10 |