| NPI | 1902491467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA BLONQUIST Manager 208-715-6709 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-03-06 |
| Last Update Date | 2025-07-25 |