| NPI | 1831065481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DONNELLY Co Owner 208-573-3053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 171400000X | |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-10-13 |