Organization
HIGH TIDE PSYCHIATRY, PLLC
Active
Other names
HIGH TIDE PSYCHIATRY
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER JANE VAN SICKLE-BIRCH PMHNP (OWNER)
(208) 557-3870
Entity
Organization
Contact information
Practice address
1500 PANCHERI DR STE 4, IDAHO FALLS, ID 83402-3212
(208) 557-3870
Mailing address
1500 PANCHERI DR STE 4, IDAHO FALLS, ID 83402-3212
(208) 557-3870
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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