Healthcare Provider Details

I. General information

NPI: 1982187324
Provider Name (Legal Business Name): LISA M RUHL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA M LARSSON

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 SUTTON ST
CALDWELL ID
83607-1913
US

IV. Provider business mailing address

3808 SUTTON ST
CALDWELL ID
83607-1913
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7567
  • Fax:
Mailing address:
  • Phone: 406-531-6493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-7604
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: