| 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 | 1041C0700X Social Worker, Clinical |
| 101YM0800X Counselor, Mental Health | |
| 101YS0200X Counselor, School | |
| 106H00000X Marriage & Family Therapist | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2021-11-01 |