MEDICARE: THE ROCK BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1598578569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROCK BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	2114 VILLAGE PARK AVE STE 200
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-441-0767
Fax Number	:	208-441-0367

Provider Business Practice Location Address
First Line	:	2114 VILLAGE PARK AVE STE 200
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-441-0767
Fax Number	:	208-441-0367

Authorized Official
Title or Position	:	BUSINESS OWNER, PROVIDER
Name	:	MICHELLE HARCOURT
Credential	:	DNP, FNP-BC
Telephone Number	:	208-220-3886

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	03/19/2025

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Directions to “THE ROCK BEHAVIORAL HEALTH ” Practice Location

Language	Start Address	Practice Location

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