Healthcare Provider Details

I. General information

NPI: 1740122647
Provider Name (Legal Business Name): MINDFUL HEALING PSYCHIATRY OF IDAHO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

IV. Provider business mailing address

8377 E COPENHAVER ST
NAMPA ID
83687-4824
US

V. Phone/Fax

Practice location:
  • Phone: 208-614-4611
  • Fax:
Mailing address:
  • Phone: 360-485-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN PURCELL
Title or Position: OWNER
Credential: MSN, PMHNP
Phone: 208-614-4611