| NPI | 1710666896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL A NYSTROM Partner/Clinician 208-791-0129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2023-07-14 |