Provider Demographics
NPI:1114315389
Name:GRAYBILL, DONNA LAURA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:LAURA
Last Name:GRAYBILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6911
Mailing Address - Country:US
Mailing Address - Phone:208-316-2851
Mailing Address - Fax:
Practice Address - Street 1:112 SHOSHONE ST E STE 210
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6185
Practice Address - Country:US
Practice Address - Phone:208-316-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULMSW-298841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical