Healthcare Provider Details

I. General information

NPI: 1376251835
Provider Name (Legal Business Name): CRESS CREEK COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MADISON PROFESSIONAL PARK
REXBURG ID
83440-2057
US

IV. Provider business mailing address

33 MADISON PROFESSIONAL PARK
REXBURG ID
83440-2057
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9304
  • Fax: 208-656-5668
Mailing address:
  • Phone: 208-243-9304
  • Fax: 208-656-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA K NELSON
Title or Position: CPC BILLING MANAGER
Credential:
Phone: 208-243-9304