Provider Demographics
NPI:1669649091
Name:CRIDDLE, REBECCA SHOFF (LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SHOFF
Last Name:CRIDDLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COUNTY ROAD 433
Mailing Address - Street 2:
Mailing Address - City:THRALL
Mailing Address - State:TX
Mailing Address - Zip Code:76578-8518
Mailing Address - Country:US
Mailing Address - Phone:352-484-4023
Mailing Address - Fax:
Practice Address - Street 1:1361 N 1075 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2750
Practice Address - Country:US
Practice Address - Phone:801-373-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9247402-3902101YM0800X, 106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health