| NPI | 1710019476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ED AXFORD Program Manager 208-234-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2020-08-22 |