| NPI | 1912285891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVIN MODRAK Owner/Member 208-319-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC4698) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC4698) |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2023-04-16 |