| NPI | 1760940639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARRETT SMITH Authorized Official/Owner 208-346-3926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2020-07-08 |