| NPI | 1902397227 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE MARY MARET Clinical Supervisor 208-818-1288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: ID DDA-5372) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2018-05-22 |