Provider Demographics
NPI:1851421077
Name:CROFT, RICK TODD (LCPC)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:TODD
Last Name:CROFT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7281
Mailing Address - Country:US
Mailing Address - Phone:208-589-8363
Mailing Address - Fax:
Practice Address - Street 1:765 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7281
Practice Address - Country:US
Practice Address - Phone:208-589-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional