| NPI | 1902170020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SKINNER Billing Manager 208-733-7186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC 2666) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |