| NPI | 1942808019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YOLANDA AMBER PONDER CEO, Clinical Director/Therapist 208-954-0597 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-12 |