| NPI | 1750705687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA JACKSON Owner 208-547-7407 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: ID 1532) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: ID 1532) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-12 |