Provider Demographics
NPI:1972943090
Name:CAUDLE, LOREN RAYMOND (LPC)
Entity type:Individual
Prefix:MR
First Name:LOREN
Middle Name:RAYMOND
Last Name:CAUDLE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S WASHINGTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-2866
Mailing Address - Country:US
Mailing Address - Phone:208-883-9927
Mailing Address - Fax:208-883-9935
Practice Address - Street 1:127 S WASHINGTON ST STE 5
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-2866
Practice Address - Country:US
Practice Address - Phone:208-883-9927
Practice Address - Fax:208-883-9935
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60200343101Y00000X
WA507297101YA0400X
IDLPC7663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)