Provider Demographics
NPI:1396474268
Name:GRAVES, RYLEE MAE (LPC)
Entity type:Individual
Prefix:MRS
First Name:RYLEE
Middle Name:MAE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:RYLEE
Other - Middle Name:MAE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:500 W IDAHO ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5755
Mailing Address - Country:US
Mailing Address - Phone:208-380-1716
Mailing Address - Fax:
Practice Address - Street 1:500 W IDAHO ST STE 201
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5755
Practice Address - Country:US
Practice Address - Phone:208-380-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty