NPI | 1871259770 |
---|---|
Entity Type | Organization |
Authorized Contact | CHERYL GREEN 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 | |
261QM0850X Clinic/Center, Adult Mental Health | |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2021-11-15 |
Last Update Date | 2024-09-18 |