Provider Demographics
NPI:1366692790
Name:SPAULDING, ROY CARSON (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:CARSON
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1610
Mailing Address - Country:US
Mailing Address - Phone:208-887-1911
Mailing Address - Fax:208-895-8049
Practice Address - Street 1:403 W CHERRY LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1610
Practice Address - Country:US
Practice Address - Phone:208-887-1911
Practice Address - Fax:208-895-8049
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-4025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist