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General NPI Number Information
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NPI Number | 1326821620
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Entity Type | Organization
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Legal Business Name | EVOLVING MINDS MENTAL HEALTH
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 824 17TH AVE S STE 5
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City | NAMPA
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State | ID
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Zip | 83651-4781
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Country | US
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Telephone | 208-918-2675
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Fax | 208-918-8627
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Provider Business Mailing Address
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Address Line | 824 17TH AVE S STE 5
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City | NAMPA
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State | ID
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Zip | 83651-4781
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Country | US
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Telephone | 208-918-2675
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Fax | 208-918-8627
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Authorized Official
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Title or Position | PARTNER/PROVIDER
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Name | AMANDA MARIE TILLEMANS
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Credential | DNP, APRN, PMHNP-BC
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Telephone | 775-247-7624
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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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