Individual
LISA K GRUTZMACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAT
Contact information
Practice address
1300 ARROWHEAD PLAZA WAY, DRIGGS, ID 83422
(208) 351-1323
Mailing address
PO BOX 1671, DRIGGS, ID 83422-1803
(208) 351-1323
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
PAT-056
WY
101YP2500X
Professional Counselor
Primary
LCPC-8588
ID
Other
Enumeration date
07/10/2012
Last updated
11/07/2022
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