| NPI | 1871126797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE CARBAJAL Director Of Operations 208-908-7882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2024-07-05 |