| NPI | 1962707166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY FERRARESE Biller 208-433-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID CS5613) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LMSW29959) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID MSW07060) | |
| 163W00000X Registered Nurse (Licence: ID N21523) | |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: ID N40356) | |
| 183500000X Pharmacist (Licence: ID CS5613) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: ID M6153) | |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2019-12-13 |