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General NPI Number Information
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NPI Number | 1124642293
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Entity Type | Organization
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Legal Business Name | WELLSPRING BEHAVIORAL HEALTH, INC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 1159 E IRON EAGLE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-6868
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Country | US
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Telephone | 208-938-2836
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Fax | 208-938-2897
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Provider Business Mailing Address
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Address Line | 1159 E IRON EAGLE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-6868
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Country | US
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Telephone | 208-938-2836
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Fax | 208-938-2897
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. ASHLEY CROFT
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Credential | DNP, PMHNP
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Telephone | 208-938-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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