Provider Demographics
NPI:1164728374
Name:GRIMM, JAMES P (LCPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:GRIMM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 MCHENRY RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1382
Mailing Address - Country:US
Mailing Address - Phone:847-913-0393
Mailing Address - Fax:847-913-9630
Practice Address - Street 1:820 E TERRA COTTA AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3649
Practice Address - Country:US
Practice Address - Phone:847-913-0393
Practice Address - Fax:847-913-9630
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.001620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional