Provider Demographics
NPI:1639460702
Name:RICHARDS, RALPH LYNN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:LYNN
Last Name:RICHARDS
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 1:3840 EAST 620 NORTH
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442
Mailing Address - Country:US
Mailing Address - Phone:208-390-8648
Mailing Address - Fax:
Practice Address - Street 1:150 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2711
Practice Address - Country:US
Practice Address - Phone:208-785-1326
Practice Address - Fax:208-785-1396
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-29567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health