Provider Demographics
NPI:1114228731
Name:GRIMES, TERESA A
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3853 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34434-4739
Mailing Address - Country:US
Mailing Address - Phone:352-425-0083
Mailing Address - Fax:
Practice Address - Street 1:3853 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34434-4739
Practice Address - Country:US
Practice Address - Phone:352-425-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst