Organization
MY BROTHER'S KEEPER MBK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATTI JOLEEN SUMMERS CPRP (OWNER)
(208) 339-4356
Entity
Organization
Contact information
Practice address
704 S COLE RD, BOISE, ID 83709-1861
(208) 339-4356
Mailing address
704 S COLE RD, BOISE, ID 83709-1861
(208) 339-4356
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
ID
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
ID
Other
Enumeration date
02/22/2012
Last updated
03/14/2013
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