| NPI | 1649818642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLORIE ELY Owner/Clinician 208-610-0996 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2023-08-08 |