Healthcare Provider Details

I. General information

NPI: 1801691647
Provider Name (Legal Business Name): RAELYNN GRANT COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S ORCHARD ST STE 128
BOISE ID
83705-1288
US

IV. Provider business mailing address

410 S ORCHARD ST STE 128
BOISE ID
83705-1288
US

V. Phone/Fax

Practice location:
  • Phone: 208-761-0980
  • Fax:
Mailing address:
  • Phone: 208-761-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAELYNN GRANT
Title or Position: OWNER/ CLINICAL COUNSELOR
Credential: LCPC
Phone: 208-761-0980