Provider Demographics
NPI:1154135465
Name:SPRING CREEK MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:SPRING CREEK MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:208-973-9413
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83431-0321
Mailing Address - Country:US
Mailing Address - Phone:208-973-9413
Mailing Address - Fax:208-216-0228
Practice Address - Street 1:711 RIGBY LAKE DR STE 102
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-5230
Practice Address - Country:US
Practice Address - Phone:208-973-9413
Practice Address - Fax:208-216-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health