| NPI | 1770927089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEDEDIAH D. PRICE Member 208-390-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 19375) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |