| NPI | 1780715045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RITCHIE WEERS Clinical Supervisor 208-234-7900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-10-22 |