| NPI | 1871915694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEE CRIDDLE Lnsw 208-241-1377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID LMSW-30202) |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2014-01-14 |