| NPI | 1669808614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY LEE EDELMANN Owner 208-651-0095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2013-09-23 |