| Cottonwood Creek Wellness Center - Lost River | |
|
1919 W State St Boise ID 83702-3958 | |
| (208) 813-6246 | |
| Not Available |
| Full Name | Cottonwood Creek Wellness Center - Lost River |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1919 W State St, Boise, Idaho |
| Authorized Official Name and Position | Janie Pickle (VP, CONTROLLER) |
| Authorized Official Contact | 6153938809 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cottonwood Creek Wellness Center - Lost River 3102 W End Ave Ste 1000 Nashville TN 37203-1324 Ph: (615) 393-8800 | Cottonwood Creek Wellness Center - Lost River 1919 W State St Boise ID 83702-3958 Ph: (208) 813-6246 |
| NPI Number | 1619534609 |
|---|---|
| Provider Enumeration Date | 05/24/2019 |
| Last Update Date | 03/22/2022 |
| Certification Date | 03/17/2022 |
| Medicare PECOS PAC ID | 3870829443 |
|---|---|
| Medicare Enrollment ID | O20190719002885 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619534609 | NPI | - | NPPES |
| Provider Name | Coire C Weathers |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437319662 PECOS PAC ID: 4385891993 Enrollment ID: I20120904000092 |
| Provider Name | Kathleen Mack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326211624 PECOS PAC ID: 1153498910 Enrollment ID: I20220930002350 |
| Provider Name | Emmy Laurie Weathers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518414606 PECOS PAC ID: 9032584164 Enrollment ID: I20230403002462 |
| Provider Name | Shawn Kathleen Jensen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831378678 PECOS PAC ID: 1658553748 Enrollment ID: I20240103004190 |
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