| 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 |