| NPI | 1871309666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTY LONG Owner/Authorized Agent 208-258-5460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| 251S00000X Community/Behavioral Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2025-09-05 |