| NPI | 1679796007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LANGE Director 208-265-5049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| 101YP2500X Counselor, Professional | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 106H00000X Marriage & Family Therapist | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-02-23 |