| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 10424 Duck Ln, Nampa, Idaho |
| Authorized Official Name and Position | Johnny Urrutia (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2082800576 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10424 Duck Ln Nampa ID 83686-9174 Ph: (208) 280-0576 | 10424 Duck Ln Nampa ID 83686-9174 Ph: (208) 280-0576 |
| NPI Number | 1477013191 |
|---|---|
| Provider Enumeration Date | 03/20/2019 |
| Last Update Date | 07/22/2020 |
| Certification Date | 07/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477013191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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