Provider Demographics
NPI:1275229072
Name:GRIMES, JEFFREY ALLISON (LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLISON
Last Name:GRIMES
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-4321
Mailing Address - Country:US
Mailing Address - Phone:314-440-6533
Mailing Address - Fax:
Practice Address - Street 1:2526 S 12TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-4321
Practice Address - Country:US
Practice Address - Phone:314-440-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional