| NPI | 1851713473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BRIDGES Owner 208-523-2080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID lcsw1103) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID lcsw1103) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |