| NPI | 1811374432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY SEAGRAVES Clinical Supervisor 208-287-5624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID 22) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |