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General NPI Number Information
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NPI Number | 1639460702
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Entity Type | Individual
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Provider Name | RALPH LYNN RICHARDS LMSW
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Gender | Male
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 150 S BROADWAY ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2711
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Country | US
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Telephone | 208-785-1326
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Fax | 208-785-1396
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Provider Business Mailing Address
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Address Line | 3840 EAST 620 NORTH
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City | RIGBY
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State | ID
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Zip | 83442
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Country | US
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Telephone | 208-390-8648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LMSW-29567
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License Number State | ID
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