Provider Demographics
NPI:1649568262
Name:GRAYHEK, PAUL A (LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:GRAYHEK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 N GALENA DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5990
Mailing Address - Country:US
Mailing Address - Phone:208-818-6304
Mailing Address - Fax:
Practice Address - Street 1:1406 N GALENA DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-5990
Practice Address - Country:US
Practice Address - Phone:208-818-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW331721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical