Provider Demographics
NPI:1124642293
Name:WELLSPRING BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:WELLSPRING BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP
Authorized Official - Phone:208-938-2836
Mailing Address - Street 1:1159 E IRON EAGLE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6868
Mailing Address - Country:US
Mailing Address - Phone:208-938-2836
Mailing Address - Fax:208-938-2897
Practice Address - Street 1:1159 E IRON EAGLE DR STE 100
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6868
Practice Address - Country:US
Practice Address - Phone:208-938-2836
Practice Address - Fax:208-938-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty