Individual
MR. GROVER LOUIS WRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2222 TETON PLZ STE 2, IDAHO FALLS, ID 83404-6485
(208) 522-4026
Mailing address
3440 E 200 N, RIGBY, ID 83442-5400
(208) 754-4913
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
690
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690
—
ID
Enumeration date
07/10/2013
Last updated
07/10/2013
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