Healthcare Provider Details

I. General information

NPI: 1336947456
Provider Name (Legal Business Name): KARA RENEE GRANT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W HAYS ST
BOISE ID
83702-5025
US

IV. Provider business mailing address

1310 W HAYS ST
BOISE ID
83702-5025
US

V. Phone/Fax

Practice location:
  • Phone: 208-803-5339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3461277
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: