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High Tide Psychiatry, PLLC

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Company Details

Name: High Tide Psychiatry, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 17 Dec 2021 (3 years ago)
Financial Date End: 31 Dec 2025
Entity Number: 4534773
Place of Formation: IDAHO
File Number: 796154
ZIP code: 83402
County: Bonneville County
Principal Address: STE 4 1500 PANCHERI DRIVE IDAHO FALLS, ID 83402
Mailing Address: STE 4 1500 PANCHERI DR IDAHO FALLS, ID 83402-3212

Agent

Name Role Address
Amber J Van Sickle-Birch Agent 1500 PANCHERI DRIVE, STE 4, IDAHO FALLS, ID 83402

Manager

Name Role Address Appointed On Resigned On
Amber J Van Sickle-Birch Manager 1500 PANCHERI DRIVE, IDAHO FALLS, ID 83402 2022-11-03 2023-02-16
Lemon Reef, PLLC Manager 1500 PANCHERI DR, IDAHO FALLS, ID 83402 2024-01-17 2024-01-17
Mountain High Mental Health, PLLC Manager 1500 PANCHERI DR., IDAHO FALLS, ID 83402 2023-02-16 No data

National Provider Identifier

NPI Number:
1023762119
Certification Date:
2022-02-08

Authorized Person:

Name:
AMBER JANE VAN SICKLE-BIRCH
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0006074965 2025-01-20
Annual Report 0005564834 2024-01-17
Amendment to Certificate 0005118099 2023-02-16
Amendment to Certificate 0005054254 2023-01-05
Annual Report 0004971596 2022-11-03

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Date of last update: 20 May 2025

Sources: Idaho Secretary of State