MEDICARE: DR. LORILEE CRITCHFIELD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	202157	ID
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	202157	ID
3	103TA0700X	Adult Development & Aging Psychologist	202157	ID
4	103TB0200X	Cognitive & Behavioral Psychologist	202157	ID
5	103TC0700X	Clinical Psychologist	202157	ID
6	103TC1900X	Counseling Psychologist	202157	ID
7	103TC2200X	Clinical Child & Adolescent Psychologist	202157	ID
8	103TF0000X	Family Psychologist	202157	ID
9	103TF0200X	Forensic Psychologist	202157	ID
10	103TM1800X	Intellectual & Developmental Disabilities Psychologist	202157	ID
11	103TP0814X	Psychoanalysis Psychologist	202157	ID
12	103TP2701X	Group Psychotherapy Psychologist	202157	ID
13	103TR0400X	Rehabilitation Psychologist	202157	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010017764	OTHER	ID	REGENCE BLUE SHIELD
2	N5798	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1912112277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORILEE CRITCHFIELD PH.D.

Provider Business Mailing Address
First Line	:	675 N CENTER ST
Second Line	:
City	:	OAKLEY
State	:	ID
Zip	:	83346-9723
Country	:	US
Telephone Number	:	208-862-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 BLUE LAKES BLVD N STE 106
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4882
Country	:	US
Telephone Number	:	208-736-7178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	09/11/2025

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