Healthcare Provider Details

I. General information

NPI: 1811985419
Provider Name (Legal Business Name): RICHARD E. BLOOD II LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 TERRACE DR
CALDWELL ID
83605-2247
US

IV. Provider business mailing address

1904 TERRACE DR
CALDWELL ID
83605-2247
US

V. Phone/Fax

Practice location:
  • Phone: 208-284-4279
  • Fax:
Mailing address:
  • Phone: 208-314-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7871697
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: