Provider Demographics
NPI:1376902817
Name:CRITCHFIELD, JOHN CLIFTON (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLIFTON
Last Name:CRITCHFIELD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 E PINE AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5922
Mailing Address - Country:US
Mailing Address - Phone:208-888-8886
Mailing Address - Fax:208-658-0153
Practice Address - Street 1:3288 E PINE AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5922
Practice Address - Country:US
Practice Address - Phone:208-888-8886
Practice Address - Fax:208-658-0153
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health