| NPI | 1720586969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD A MONTGOMERY Member 208-345-2212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2018-01-23 |