Provider Demographics
NPI:1811389299
Name:CROSSPOINTE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:CROSSPOINTE MENTAL HEALTH, LLC
Other - Org Name:CROSSPOINTE FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-736-7090
Mailing Address - Street 1:1415 FILLMORE STREET
Mailing Address - Street 2:SUITE 702 AND 703
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3392
Mailing Address - Country:US
Mailing Address - Phone:208-736-7090
Mailing Address - Fax:208-736-7089
Practice Address - Street 1:1415 FILLMORE ST
Practice Address - Street 2:SUITE 702 & 703
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3399
Practice Address - Country:US
Practice Address - Phone:208-736-7090
Practice Address - Fax:208-736-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1386914505Medicaid