Individual
MRS. RAELYNN FRITZ GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
410 S ORCHARD ST STE 132, BOISE, ID 83705-1288
(208) 761-0980
Mailing address
1415 S COLORADO AVE, BOISE, ID 83706-3741
(208) 761-0980
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC 4853
ID
Other
Enumeration date
06/07/2012
Last updated
06/11/2012
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