| NPI | 1679238190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY BLACKWOOD Credentialing Specialist 208-737-6718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041S0200X Social Worker School |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YS0200X Counselor School | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |