Provider Demographics
NPI:1275759714
Name:GRIMSLEY, CHERYLLANN (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYLLANN
Middle Name:
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8807 CHILLIWACK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5250
Mailing Address - Country:US
Mailing Address - Phone:210-445-0408
Mailing Address - Fax:210-888-2218
Practice Address - Street 1:11122 WURZBACH, STE. 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-669-0345
Practice Address - Fax:210-888-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1702771Medicaid
TX11897898OtherCAQH
TX1702771Medicaid