| NPI | 1922865146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY HOWARD Owner 208-682-0572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-03-04 |