| NPI | 1861765620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA LEIGH DAVENPORT Owner 208-716-2944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-03-01 |