=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760391478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHERRY CREEK COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2026
-----------------------------------------------------
Last Update Date | 09/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 MORRISON ST
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-5451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-308-5682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2032 E 2200 N
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-0625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-308-5682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELSIE ROBINSON
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 208-308-5682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------