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General NPI Number Information
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NPI Number | 1275675886
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Entity Type | Organization
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Legal Business Name | SAND CREEK MENTAL HEALTH AND WELLNESS
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 212 N 1ST AVE STE G101
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City | SANDPOINT
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State | ID
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Zip | 83864-1400
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Country | US
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Telephone | 208-263-7180
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Fax | 208-255-2017
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Provider Business Mailing Address
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Address Line | 212 N 1ST AVE STE G101
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City | SANDPOINT
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State | ID
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Zip | 83864-1400
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Country | US
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Telephone | 208-263-7180
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Fax | 208-255-2017
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. SUSAN STEVENS
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Credential | LMFT
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Telephone | 208-263-7180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-26084
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License Number State | ID
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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 | LCSW-335
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-2843
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-2054
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License Number State | ID
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