| NPI | 1871230086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY PAMELA DAGLEN Clinical Mental Health Counselor 208-515-1988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |