Healthcare Provider Details

I. General information

NPI: 1710626569
Provider Name (Legal Business Name): GLADE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DR
TWIN FALLS ID
83301-7441
US

IV. Provider business mailing address

493 EASTLAND DR
TWIN FALLS ID
83301-7441
US

V. Phone/Fax

Practice location:
  • Phone: 208-404-3495
  • Fax: 208-718-1106
Mailing address:
  • Phone: 208-404-3495
  • Fax: 208-718-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTAN NICHOLE FRENCH
Title or Position: OWNER
Credential: LCSW
Phone: 208-404-3495