| NPI | 1700575024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN LOUISE JONES Authorized Official 208-421-0238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-06-17 |