| NPI | 1649756057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANDICE CHAELEE PETERSON Co Owner 208-339-0909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-07-18 |