Provider Demographics
NPI:1114114063
Name:GRIMES, KAREN S (CBHCM)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:S
Last Name:GRIMES
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772-3643
Mailing Address - Country:US
Mailing Address - Phone:580-623-2545
Mailing Address - Fax:
Practice Address - Street 1:120 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772-3643
Practice Address - Country:US
Practice Address - Phone:580-623-2545
Practice Address - Fax:580-623-7290
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCERTIFICATE #20070171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator