| NPI | 1699015511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI CRABB Manager 208-867-0561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID PSY-202233) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2013-03-01 |