| NPI | 1851454250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL J EISENBEISS Owner 208-376-3546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ID PSY57) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2010-06-09 |