| NPI | 1942546510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CRUZ Owner 208-313-0711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-12-29 |
| Last Update Date | 2012-12-29 |