| NPI | 1700046612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LANGE Director 208-265-5049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| 1041C0700X Social Worker, Clinical | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2011-02-23 |