Provider Demographics
NPI:1609978113
Name:LIMB, RODNEY DALE (LCPC, LMFT, LPC)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:DALE
Last Name:LIMB
Suffix:
Gender:M
Credentials:LCPC, LMFT, LPC
Other - Prefix:MR
Other - First Name:ROD
Other - Middle Name:
Other - Last Name:LIMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, LMFT, LPC
Mailing Address - Street 1:1426 N CAROL ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1844
Mailing Address - Country:US
Mailing Address - Phone:208-577-6277
Mailing Address - Fax:208-577-6277
Practice Address - Street 1:1426 N CAROL ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1844
Practice Address - Country:US
Practice Address - Phone:208-887-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC344101YM0800X
IDLMFT28106H00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010029198OtherBLUE SHIELD
IDQ1430OtherBLUE CROSS