WELLSPRING BEHAVIORAL HEALTH, INC (NPI# 1124642293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124642293 |
| Entity Type | Organization |
| Organization Name | WELLSPRING BEHAVIORAL HEALTH, INC |
| Practice Address |
1159 E Iron Eagle Dr Ste 100 Eagle ID 83616-6868 |
| Practice Telephone | 2089382836 |
| Practice Fax Number | 2089382897 |
| Mailing Telephone | 2089382836 |
| Mailing Fax Number | 2089382897 |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |
| Authorized Official Name | DR. ASHLEY CROFT (OWNER/PROVIDER) |
| Authorized Official Telephone | 2089382836 |
| Authorized Official Credential | DNP, PMHNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | WELLSPRING BEHAVIORAL HEALTH, INC. | 1159 E Iron Eagle Dr Ste 100, Eagle, ID 83616 |
| Street Address |
1159 E IRON EAGLE DR STE 100 |
| City | EAGLE |
| State | ID |
| Zip Code | 83616-6868 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1851870380 | Sarah Gabriel | Nurse Practitioner | 137 Howard Street, Eagle, CO 81632 | 2018-08-07 |
| 1124395900 | Patricia Rose Koepl | Nurse Practitioner | 1032 S Bridge Way Pl, Suite 100, Eagle, ID 83616-6099 | 2011-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245857952 | Lidia Timofeenko Petersen | Nurse Practitioner | 775 Wayne Ave, Pocatello, ID 83201-3718 | 2020-06-29 |
| 1790302594 | Dumu Psychiatry LLC | Nurse Practitioner | 9428 W Fairview Ave, Boise, ID 83704-8101 | 2020-06-29 |
| 1861024689 | Jessica Erin Bringman | Nurse Practitioner | 3624 23rd St, Lewiston, ID 83501-6121 | 2020-02-10 |
| 1528610532 | Shawn Warren | Nurse Practitioner | 755 Lomax St, Idaho Falls, ID 83401-2786 | 2019-07-10 |
| 1760950604 | Scott A Watkins | Nurse Practitioner | 2836 Cougar Ave, Nampa, ID 83687-9107 | 2018-11-08 |
| 1104309657 | Brigitta Panther | Nurse Practitioner | 418 W Reese St, Boise, ID 83706-6233 | 2018-09-11 |
| 1659870178 | Mark Mcgrath | Nurse Practitioner | 1309 Ponderosa Dr Ste 103, Sandpoint, ID 83864-8278 | 2018-02-10 |
| 1467855403 | Clint Emmett | Nurse Practitioner | 875 Perimeter Dr # Ms 3140, Moscow, ID 83844-2006 | 2014-10-06 |
| 1639507551 | Jason Martin | Nurse Practitioner | 13734 S 1st E, Idaho Falls, ID 83404-7852 | 2013-10-31 |
| 1881027241 | Colleen R Fleming | Nurse Practitioner | 2025 W Park Place, Ste B, Coeur D Alene, ID 83814-2785 | 2013-08-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.