| NPI | 1790131027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE NUBILE Clinical Supervisor 208-334-0824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-5579) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2016-05-05 |