| NPI | 1871489716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMIAH S LEGG Licensed Clinical Social Worker 208-989-9143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |