| NPI | 1780847913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LANGE Director 208-265-5049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2013-07-30 |