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CLEARWATER PSYCHIATRY PLLC

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Company Details

Name: CLEARWATER PSYCHIATRY PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 26 Apr 2021 (4 years ago)
Financial Date End: 30 Apr 2026
Entity Number: 4256289
Place of Formation: IDAHO
File Number: 760402
ZIP code: 83616
County: Ada County
Principal Address: 272 W RIVER MEADOW DR EAGLE, ID 83616
Mailing Address: CINDY SEVIERI STE 101 413 N ALLUMBAUGH ST BOISE, ID 83704-9219

Agent

Name Role Address
DAVID THOMPSON Agent 272 W RIVER MEADOW DR, EAGLE, ID 83616

Member

Name Role Address Appointed On
DAVID THOMPSON M.D. Member 272 W RIVER MEADOW DR, EAGLE, ID 83616 2022-03-30

U.S. Small Business Administration Profile

Phone Number:
Contact Person:
ROBIN CALDWELL
User ID:
P3351667

Unique Entity ID

Unique Entity ID:
SXLFZCRYAK63
CAGE Code:
0PQW7
UEI Expiration Date:
2025-12-10

Business Information

Activation Date:
2024-12-12
Initial Registration Date:
2024-12-10

National Provider Identifier

NPI Number:
1487318960
Certification Date:
2021-10-29

Authorized Person:

Name:
CHERI PETERSON
Role:
CREDENTIALING SPECIALIST
Phone:

Taxonomy:

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

Contacts:

Fax:
2083239604

Filing

Filing Name Filing Number Filing date
Annual Report 0006157955 2025-03-12
Annual Report 0005634948 2024-03-05
Annual Report 0005135134 2023-03-03
Annual Report 0004676379 2022-03-30
Statement of Change of Business Mailing Address 0004453936 2021-10-14

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Date of last update: 23 Jul 2025

Sources: Idaho Secretary of State