Provider Demographics
NPI:1710092739
Name:RITCHIE, STEPHEN J (LCPC, MAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:RITCHIE
Suffix:
Gender:M
Credentials:LCPC, MAC
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC, MAC
Mailing Address - Street 1:258 PLANTATION CIR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7990
Mailing Address - Country:US
Mailing Address - Phone:208-523-5978
Mailing Address - Fax:
Practice Address - Street 1:496 A ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3617
Practice Address - Country:US
Practice Address - Phone:208-552-7100
Practice Address - Fax:208-552-7101
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID35620101YA0400X
IDLCPC-169101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150854OtherREGENCE BLUE SHIELD OF ID
IDQ6157OtherBLUE CROSS OF IDAHO
IDQ6157OtherBLUE CROSS OF IDAHO