Provider Demographics
NPI:1417681735
Name:GRIMM, KRISTINA (MED, LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BROADWAY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2143
Mailing Address - Country:US
Mailing Address - Phone:814-933-8100
Mailing Address - Fax:
Practice Address - Street 1:4001 STONEWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8398
Practice Address - Country:US
Practice Address - Phone:724-747-1690
Practice Address - Fax:412-763-1235
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014638101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional