Provider Demographics
NPI:1003960576
Name:GRIMES, LOUISE A (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:A
Last Name:GRIMES
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E COLORADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2803
Mailing Address - Country:US
Mailing Address - Phone:626-256-3810
Mailing Address - Fax:626-303-5850
Practice Address - Street 1:135 W LEMON AVE
Practice Address - Street 2:B
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2809
Practice Address - Country:US
Practice Address - Phone:626-256-3810
Practice Address - Fax:626-303-5850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36973106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist