Provider Demographics
NPI:1093445439
Name:MESSENGER-GRAPP, AMELIA (LPC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:MESSENGER-GRAPP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 S BROXON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2442
Mailing Address - Country:US
Mailing Address - Phone:208-713-5533
Mailing Address - Fax:
Practice Address - Street 1:3501 W ELDER ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4986
Practice Address - Country:US
Practice Address - Phone:208-286-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional