| NPI | 1679860746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK EDWARD RICHMAN Partner 208-946-5242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-4465) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: ID LPC-4235) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2011-07-08 |