Provider Demographics
NPI:1518361229
Name:FRALEY & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:FRALEY & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRALEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-710-8171
Mailing Address - Street 1:504 MAIN ST
Mailing Address - Street 2:SUITE 422
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1803
Mailing Address - Country:US
Mailing Address - Phone:509-710-8171
Mailing Address - Fax:208-247-9247
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:SUITE 422
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1803
Practice Address - Country:US
Practice Address - Phone:509-710-8171
Practice Address - Fax:208-247-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3873251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health