| NPI | 1902259609 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY DESANTIS Owner/Therapist 208-807-0122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ID LCPC-4671) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |