| NPI | 1831226547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORA JO GUSSENHOVEN Program Manager 208-769-1406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |