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General NPI Number Information
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NPI Number | 1154135465
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Entity Type | Organization
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Legal Business Name | SPRING CREEK MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 02/05/2025
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 711 RIGBY LAKE DR STE 102
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City | RIGBY
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State | ID
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Zip | 83442-5230
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Country | US
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Telephone | 208-973-9413
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Fax | 208-216-0228
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Provider Business Mailing Address
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Address Line | PO BOX 321
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City | LEWISVILLE
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State | ID
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Zip | 83431-0321
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Country | US
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Telephone | 208-973-9413
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Fax | 208-216-0228
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Authorized Official
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Title or Position | OWNER
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Name | TY COTTLE
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Credential | PMHNP-BC
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Telephone | 208-973-9413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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