Provider Demographics
NPI:1528595329
Name:CRAIG, RICHARD D (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:CRAIG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 W WINDCHIME DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3535
Mailing Address - Country:US
Mailing Address - Phone:208-994-1672
Mailing Address - Fax:
Practice Address - Street 1:2178 W WINDCHIME DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-3535
Practice Address - Country:US
Practice Address - Phone:208-994-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPSY-202367OtherLICENSE