| NPI | 1740646561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA J GERDES Counselor 208-291-0005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 6130) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-04-26 |