| NPI | 1689984254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD HURT Program Manager 208-455-7057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2010-10-18 |