| NPI | 1871259770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GOTTS Billing Supervisor 208-505-4419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 175T00000X Peer Specialist | |
| 251B00000X Case Management | |
| 251S00000X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2022-04-14 |