| NPI | 1710545413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA C WENIG Provider/Owner 208-930-4003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |