NPI age
19 years
Enumerated 2007-03-21
Across 806 active community/behavioral health providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 80636100 | |
| 05 (ID) | 806648000 | |
| 05 (ID) | 806361001 |
Single-site organization. Only one practice location on file.
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