Healthcare Provider Details

I. General information

NPI: 1386914505
Provider Name (Legal Business Name): CROSSPOINTE MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 FILLMORE ST
TWIN FALLS ID
83301-3392
US

IV. Provider business mailing address

1363 FILLMORE ST
TWIN FALLS ID
83301-3392
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-7090
  • Fax: 208-736-7089
Mailing address:
  • Phone: 208-736-7090
  • Fax: 208-736-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateID
# 7
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateID

VIII. Authorized Official

Name: MRS. NYLA M JENSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-736-7090