| NPI | 1699214007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GRAY Social Worker 208-678-3555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LMSW-35853) |
| Enumeration Date | 2017-02-17 |
| Last Update Date | 2017-02-17 |