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FootHills Psychiatry and Addiction, PLLC

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Company Details

Name: FootHills Psychiatry and Addiction, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Inactive-Dissolved
Date of registration: 12 Jun 2020 (5 years ago)
Financial Date End: 30 Jun 2022
Date dissolved: 29 Oct 2021
Entity Number: 3908095
Place of Formation: IDAHO
File Number: 713381
ZIP code: 83404
County: Bonneville County
Principal Address: 13734 S. 1ST EAST IDAHO FALLS, ID 83404
Mailing Address: STE D 112 S MAIN ST FIRTH, ID 83236-1168

Agent

Name Role Address
Jason Martin Agent 112 S. MAIN ST, SUITE D, FIRTH, ID 83236

Manager

Name Role Address Appointed On
Jason Martin Manager 112 S. MAIN ST, FIRTH, ID 83236 2021-05-06

National Provider Identifier

NPI Number:
1023635018
Certification Date:
2020-06-25

Authorized Person:

Name:
JASON MARTIN
Role:
PSYCHIATRIC NURSE PRACTITIONER
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Statement of Dissolution 0004463990 2021-10-29
Annual Report 0004276276 2021-05-06
Initial Filing 0003908095 2020-06-12

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Date of last update: 18 May 2025

Sources: Idaho Secretary of State