| NPI | 1700129491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALITA RUBY Administrative Service Manager 208-454-8389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2023-03-08 |