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General NPI Number Information
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NPI Number | 1366389603
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PINE THERAPY PLLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 555 BURNSIDE AVE
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City | MIDDLETON
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State | ID
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Zip | 83644-1141
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Country | US
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Telephone | 208-695-3231
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Fax |
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Provider Business Mailing Address
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Address Line | 555 BURNSIDE AVE
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City | MIDDLETON
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State | ID
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Zip | 83644-1141
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Country | US
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Telephone | 208-695-3231
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | TIMOTHY L STREIGHT
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Credential | LPC
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Telephone | 208-695-3231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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