Healthcare Provider Details

I. General information

NPI: 1275675886
Provider Name (Legal Business Name): SAND CREEK MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N 1ST AVE STE G101
SANDPOINT ID
83864-1400
US

IV. Provider business mailing address

212 N 1ST AVE STE G101
SANDPOINT ID
83864-1400
US

V. Phone/Fax

Practice location:
  • Phone: 208-263-7180
  • Fax: 208-255-2017
Mailing address:
  • Phone: 208-263-7180
  • Fax: 208-255-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW-2054
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-26084
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-335
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-2843
License Number StateID

VIII. Authorized Official

Name: MRS. SUSAN STEVENS
Title or Position: PARTNER
Credential: LMFT
Phone: 208-263-7180