Healthcare Provider Details

I. General information

NPI: 1932856135
Provider Name (Legal Business Name): MOUNTAIN HOME BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 AMERICAN LEGION BLVD STE A
MOUNTAIN HOME ID
83647-3166
US

IV. Provider business mailing address

1225 E 18TH N
MOUNTAIN HOME ID
83647-1822
US

V. Phone/Fax

Practice location:
  • Phone: 208-409-7122
  • Fax:
Mailing address:
  • Phone: 208-409-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. REYSAN R COTTON
Title or Position: OWNER
Credential: BS RN
Phone: 208-409-7122