Provider Demographics
NPI:1225346307
Name:GRIMES, JIM S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:S
Last Name:GRIMES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 W IMPERIAL HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3735
Mailing Address - Country:US
Mailing Address - Phone:714-496-7955
Mailing Address - Fax:
Practice Address - Street 1:1215 W IMPERIAL HWY STE 207
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3735
Practice Address - Country:US
Practice Address - Phone:714-496-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-22
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21266103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist