| NPI | 1689218018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA MCCOY Office Manager / Billing Specialist 208-242-9087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2022-04-13 |