| NPI | 1770105850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW TYSON HANSEN Owner 208-777-2169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 104100000X Social Worker | |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2024-02-01 |