| NPI | 1821677113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI OLSON Owner 208-713-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2024-01-21 |