Provider Demographics
NPI:1770358954
Name:RYLEE GRAVES COUNSELING LLC
Entity type:Organization
Organization Name:RYLEE GRAVES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-869-5172
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty