| NPI | 1689109613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW R LARSON Owner 208-866-3427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCSW-33519) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2020-03-26 |