Provider Demographics
NPI:1376931543
Name:RAINSDON, TODD DAVID (LMSW)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DAVID
Last Name:RAINSDON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 PARKCENTRE WAY
Mailing Address - Street 2:SUITE 7
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1745
Mailing Address - Country:US
Mailing Address - Phone:208-442-7791
Mailing Address - Fax:208-442-7792
Practice Address - Street 1:915 PARKCENTRE WAY
Practice Address - Street 2:SUITE 7
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1745
Practice Address - Country:US
Practice Address - Phone:208-442-7791
Practice Address - Fax:208-442-7792
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-34291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker