Provider Demographics
NPI:1285818773
Name:GRIMES, TIMOTHY RONALD
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RONALD
Last Name:GRIMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1912
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-1912
Mailing Address - Country:US
Mailing Address - Phone:615-483-7007
Mailing Address - Fax:931-489-0033
Practice Address - Street 1:5311 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2450
Practice Address - Country:US
Practice Address - Phone:615-483-7007
Practice Address - Fax:931-489-0033
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN00001960101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health