Individual
ROZALYNNE M BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
102 N COLLEGE ST, GRANGEVILLE, ID 83530-1912
(208) 983-0235
(208) 983-0245
Mailing address
102 N COLLEGE ST, P.O. BOX 627, GRANGEVILLE, ID 83530-1912
(208) 983-0235
(208) 983-0245
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC4718
ID
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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