| NPI | 1780100719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL DEE CLARK Owner/Operator 208-497-1290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-34365) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-25042) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT-2661) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2017-08-22 |