| NPI | 1699829440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA DOCKSTADER Director 208-543-4494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID lmsw1389) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-08-22 |