| NPI | 1922582501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAREY DAWN CRILL Owner 208-283-7314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2019-02-01 |