| NPI | 1992007249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY WALL Office Manager 208-365-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2023-08-03 |