| NPI | 1790668069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENN GALLUP Psychologist 208-406-2492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-25 |