| NPI | 1659599850 |
|---|---|
| Doing Business As | INTERMOUNTAIN CENTER FOR AUTISM & CHILD DEVELOPMENT |
| Entity Type | Organization |
| Authorized Contact | TYLER T WHITNEY President 208-888-7104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID SE-202327) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID SE202-374) |
| 103T00000X Psychologist (Licence: ID PSY202-131) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2020-08-22 |