Provider Demographics
NPI:1225253073
Name:FRALEY, LYNN ALISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ALISON
Last Name:FRALEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MAIN
Mailing Address - Street 2:SUITE 422
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:509-710-8171
Mailing Address - Fax:208-247-9247
Practice Address - Street 1:504 MAIN
Practice Address - Street 2:SUITE 422
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:509-710-8171
Practice Address - Fax:208-247-9247
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007678101YM0800X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00007678OtherSTATE LICENSE