| NPI | 1861759854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN J HULBERT Owner 208-898-8999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ID PSY-282) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ID PSY-282) |
| 103TC1900X Psychologist Counseling (Licence: ID PSY-282) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2012-04-16 |