| Doctor Name: | MS. THERESA LYNN GRABER-GIMMESON |
| NPI Number: | 1740615772 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC-5107 |
| Business Practice Address: | 106 Michigan Avenue Orofino, ID - 835445194 |
| Business Phone Number: | 2084764440 |
| Business Fax Number: | 2084764441 |
| Mailing Address: | 175 Highland Ct, OROFINO |
| State: | ID |
| Postal Code: | 835449635 |
| Phone Number: | 2087916871 |
| Fax Number: | |
| NPI Enumeration Date: | 09/10/2013 |
| NPI Last Update Date: | 05/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-5107 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |