| NPI | 1912300948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY WRAY President 208-421-2908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ID NP-1476A) |
| Enumeration Date | 2014-10-05 |
| Last Update Date | 2014-10-05 |