| NPI | 1740057025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LUDWIG Owner/Clinician 208-599-5121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2023-12-07 |