| NPI | 1821459272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATY SIMMONS Billing/Credentialing 208-452-6580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 4565) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2016-03-14 |