Provider Demographics
NPI:1740615772
Name:GRABER-GIMMESON, THERESA LYNN (LPC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:LYNN
Last Name:GRABER-GIMMESON
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 1:175 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9635
Mailing Address - Country:US
Mailing Address - Phone:208-791-6871
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544
Practice Address - Country:US
Practice Address - Phone:208-476-4440
Practice Address - Fax:208-476-4441
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional