NPI | 1902398548 |
---|---|
Entity Type | Organization |
Authorized Contact | KAILEE MCMAHON Registered Agent 208-407-1180 |
Organization Subpart ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-6860) |
Enumeration Date | 2018-05-30 |
Last Update Date | 2018-05-30 |