| NPI | 1881425098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY ANN SPANGLER Administrator 208-477-7291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-08-09 |