| NPI | 1912891433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | APRIL V ROSE Member 208-918-2588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2026-07-07 |