# HIGH TIDE PSYCHIATRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HIGH TIDE PSYCHIATRY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023762119
- **Authorized official:** AMBER JANE VAN SICKLE-BIRCH PMHNP (OWNER)
- **Authorized official phone:** (208) 557-3870

## Contact information

- **Practice address:** 1500 PANCHERI DR STE 4, IDAHO FALLS, ID 83402-3212
- **Practice address phone:** (208) 557-3870
- **Mailing address:** 1500 PANCHERI DR STE 4, IDAHO FALLS, ID 83402-3212
- **Mailing address phone:** (208) 557-3870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/08/2022
- **Last updated:** 02/08/2022