| NPI | 1972261162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYNN TOBIAS Owner 208-870-6343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-12-04 |
| Last Update Date | 2021-12-04 |