| NPI | 1902357965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH ARLENE GOSS Credentialing 208-221-1161 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW 34676) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2023-06-09 |