| NPI | 1972307254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRIC MUKULU Owner 208-280-3508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-07 |