| NPI | 1811502438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE KEVIN WILSON Owner/Social Worker 208-713-9627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-09-10 |