| NPI | 1750859781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARRETT PRICE Owner 208-409-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2020-06-29 |