| NPI | 1699413757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN MICHAEL JENNINGS Lcsw 208-416-3850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2023-01-11 |