| NPI | 1821376773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKKI TANGEN Owner 208-322-4722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: ID LPC-4515) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2011-07-26 |